Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013 2014 2015 2016 2017 2018

Details for Mechanism ID: 9043
Country/Region: Uganda
Year: 2012
Main Partner: Henry M. Jackson Foundation for the Advancement of Military Medicine
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USDOD
Total Funding: $5,851,858

Since 2005, The Henry M. Jackson Foundation has officially received funds and transferred them to The Makerere University Walter Reed Project (MUWRP) in Uganda to implement HIV care, treatment and prevention activities. The MUWRP goals are to build the capacity and systems of local public and private partners in Uganda to ensure sustainable, quality HIV services. Since 2005, MUWRP has supported HIV programs including: expansion of HIV clinical sites, provision of laboratory capacity, district-level data system strengthening, supply-chain management strengthening, human capacity development, youth-focused programs, short-term technical staffing, comprehensive home-based OVC services, and a variety of counseling and testing and prevention programs, including medical male circumcision and house-to-house testing. MUWRP manages only data-driven programs from ongoing program monitoring and evaluation. MUWRPs strong emphasis on efficiency has achieved improved economies in procurement, highly coordinated service delivery, and expanded coverage of programs with low marginal costs. In 2011, a USG-Uganda rationalization effort resulted in the directive of MUWRP greatly expanding its service area coverage. Therefore, beginning October 1, 2011, MUWRP became the only PEPFAR implementer for all PEPFAR Program Areas for the three Uganda districts of Kayunga, Mukono and Buvuma. Cooperative agreements will be entered into with each district to transition many activities to local governments. The demographics of these districts include large MARP populations with a total target population > 1.2 million persons. Since 2005, MUWRP has purchased five vehicles and plans to purchase one vehicle (approximate cost $40,000) in 2013 to transport its mobile circumcision camp.

Funding for Care: Adult Care and Support (HBHC): $725,595

PEPFAR will focus on supporting the Government of Uganda (GOU) to further expand access to HIV care and support with the goal to achieve universal access of 80% in care by 2015. Makerere University Walter Reed Project (MUWRP) will support the provision of care services to 19495 as a contribution to the overall PEPFAR target of 812,989 HIV positive individual in care and support services. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations 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. MUWRP will implement approaches to promote an effective CoR model and monitor key indicators along the continuum. MUWRP will work in three districts in Uganda: Kayunga, Mukono and Buvuma (an island in lake victoria)MUWRP will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthen positive health dignity and prevention (PHDP); strengthen linkages and referrals using linkage facilitators; implement quality improvement for adherence and retention; pain and symptom management; and provide support to targeted community outreaches in high prevalence hard to reach and underserved areas.

Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation 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. MUWRP will support one laboratory Hub in Kayunga and 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, it will regularly keep track and report on client waiting lists if any.Also, MUWRP will support one viral load test per ART patient per year.

MUWRP will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, liaise with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for other HIV commodities (cotrimoxazole, lab reagents). MUWRP will build the capacity of facility staff to accurately and timely reports, forecast, quantify and order commodities.In addition, MUWRP 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 nutritional services. Collaboration with other key stakeholders at all levels for provision of required wrap around services including family planning, etc. will occur.The program will be aligned to the National Strategic Plan for HIV/AIDS (2011/12 2014/15); support and strengthen the national M&E systems; and work within district health plans. MUWRP will work under the guidance of MoH AIDS Control Program (ACP) and Quality Assurance Department for trainings, mentorship and support supervision.Funding has been provided to support the recruitment of 09 additional staff in the districts to meet the achievement of the targets. This will be done working with the Health Systems Strengthening technical working group.

Funding for Care: Orphans and Vulnerable Children (HKID): $600,000

Through FY 2011, MUWRP has supported an OVC home-based counseling and follow-up program that provides community-based outreach, counseling, and education for OVCs residing in Kayunga district, and utilizes three HIV clinics in Mukono district. In FY 2012, MUWRPs coverage area will significantly expand to include all of Kayunga, Mukono and Buvuma districts. MUWRPs support for these OVCs will continue as described below through CBO partnerships and district-based programming. Home-based visits and school fees for 200 OVCs will be supported by MUWRP. The programs target population is children up to age 18 who have lost a parent to HIV/AIDS; who are otherwise directly affected by the disease; or who live in areas of high HIV prevalence and may be vulnerable to the disease or its socioeconomic effects. As a result of the expansion described above, the numbers of OVCs within the MUWRP catchment area in FY 2012 will more than double, and will incorporate many isolated fishing villages along the River Nile and islands on Lake Victoria. MUWRPs OVC program is part of a comprehensive HIV/AIDS program and has strong links to other program areas, especially Pediatric Care & Treatment, PMTCT, Lab, HTC, Prevention, and Strategic Information. Specifically, the OVC programs priorities lie in improving families/households, service delivery, community support and coordination, and provision of education to MARP OVCs. For the OVCs themselves, the program activities include home visits for monitoring treatment adherence and well-being, and ensuring that they are provided with the minimum package for OVCs as defined by PEPFAR, including play rooms at HIV clinics. For the families of OVCs, the program activities include home-based services which incorporate HIV education, counseling, psychosocial/emotional support, and nutritional evaluation/counseling; and for the most needy, scholastic materials, clothes, blankets, mattresses, and supplemental food. Specifically for the OVC caregivers, MUWRP will continue to provide technical assistance on caring for pediatric ART/HIV+ patients, symptom control, and linkages to other caregivers of OVCs for group/peer counseling and psychosocial support. These meetings are held once per month at each MUWRP-supported HIV clinic. The OVC program is data-driven by means of routine monitoring and evaluation (M&E). For example, MUWRP allows caregivers of OVCs to participate in MUWRP-supported patient farms, a large scale income generating program. M&E data show that all caregivers of OVCs who have participated in the farms have benefited (on average) by earning $47 per harvest. Further, M&E data reveal that > 80% of MUWRP-supported OVCs were deemed adherent as per Uganda MOH standards. In FY 2012, MUWRP will continue to support the Kayunga District Youth Recreational Center, which was founded in 2006 by the Kayunga District Government and MUWRP. The goals of this facility are to build district capacity in identifying and providing HIV services to youth and especially OVC. The Center currently provides counseling, care, and recreational space specifically geared toward youth between the ages of 12 and 18 who are HIV+ or defined as OVCs. HIV+ youth are strongly referred for evaluation for ART. To date, 26 OVCs volunteering at the Center have been awarded contracts with MUWRP to work in areas such as VMMC, SI or HIV Care, and others were given scholarships to start a business or attend university.

Funding for Care: TB/HIV (HVTB): $177,422

MUWRP will focus on supporting the GOU to scale up TB/HIV integration; and specifically the PEPFAR goal to achieve TB screening of 90% (731,690) of HIV positive clients in care. In addition, initiate 24,390 HIV positive clients in care on TB treatment. This target was derived using burden tables based on district HIV prevalence and treatment need. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages.MUWRP will contribute to this target by screening 17546 HIV positive clients for TB; and 858 will be started on TB treatment. MUWRP will support three districts: Kayunga, Mukono and Buvuma (an island in lake victoria).

MUWRP 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 at Kayunga Hospital Laboratory hub. MUWRP will support MDR-TB surveillance through sputum sample transportation to the Gene Xpert hub and receipt of results at facilities.In FY13, MUWRP 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. MUWRP 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; ensure adequate natural ventilation; etc.

The MOH/ACP and NTLP will be supported to roll out provision of IPT, in line with the WHO recommendations.

In addition, MUWRP 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 nutritional services. MUWRP will collaborate with other key stakeholders at all levels for provision of required wrap around services.The program will be aligned to the National Strategic Plan for HIV/AIDS and National TB Strategic Plan (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. MUWRP will work under the guidance of MoH AIDS Control Program, National TB and Leprosy Program and Quality Assurance Department in trainings, TB/HIV mentorship and support supervision. Additionally, MUWRP will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

Funding for Care: Pediatric Care and Support (PDCS): $35,199

MUWRP will focus on supporting the GOU to further expand pediatric HIV care and OVC with the goal to achieve universal access to care by 2015. MUWRP will contribute 19,495 to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services of which 74,555 are children. MUWRP will support three districts: Kayunga, Mukono and Buvuma (an island in lake victoria)

MUWRP 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. EID services and focal points at facilities will be scaled up to ensure follow up and active search of exposed children in facilities and communities to enable early enrolment of children in care. A focus will be on scaling up low cost approaches, such as use of care taker support groups so as to support retention in care. MUWRP 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 pre-ART children for ART eligibility to ensure timely initiation on treatment in line with MoH guidance.

MUWRP 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 PWP /PHDP services including, sexual and RH services, psychosocial support and life skills training. Lessons learned from the planned national adolescent service assessment will be incorporated in activities.

A key priority will be to establish strong referrals between OVC and care and support programs to ensure HIV positive children are linked to OVC services, and children provided with OVC services are screened for HIV and appropriately linked to care and support. MUWRP will also support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

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

MUWRP 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. MUWRP will collaborate with UNICEF and other key stakeholders at all levels for provision of required wrap around services.The program will be aligned to the National Strategic Plan for HIV/AID (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. MUWRP will work under the guidance of MoH AIDS Control Program and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and support supervision.

Funding for Laboratory Infrastructure (HLAB): $585,635

MUWRP supports Kayunga district, Mukono district and Buvuma Islands. The only hub for MUWRP is Kayunga hospital, which has already been equipped with capacity for CD4+ testing, viral load, Gene X pert, clinical chemistry and hematology tests. With the recent addition of Buvuma district, a potentially MARP district comprising of fisher folks and other mobile populations, will require interventions that target these populations. Therefore expansion of CD4+ testing services to increase access to testing and timely assessment for ART eligibility and initiation. MUWRP will in collaboration with the district authorities and CPHL invest in start-up training and implementation of SLMTA to the targeted score for that level of facility. During the same period will support recruitment of 2 laboratory technologists and 5 laboratory technicians to ensure improved standard and quality of testing. MUWRP will procure motorbike and appropriate riding gear; hire a rider and ensure that specimen referral/networking and results dispatch following testing get to the desired patients on time. To increase on precision of laboratory reagent/supplies usage and mitigate stock outs, MUWRP will undertake QA/LQMS training, mentoring and support supervision for laboratory staff.

MUWRP will set up and support a referral network for EID samples to CPHLMUWRP will support 3 Labs in at Naggalama Hospital and Mukono Health Center IV (church of Uganda).

Funding for Strategic Information (HVSI): $188,000

Makarere University Walter Reed Project (MUWRP) is funded to support Pivot 4 Technological innovations to track referrals, linkages and retention of HIV+ patients. contribute to technological innovations to track referrals, linkages and retention. In FY 2011, MUWRP customized and implemented an electronic medical records (EMR) system at the Kayunga District Hospital. The EMR is now fully operational and links all patient data (including clinical, laboratory, pharmacy, appointments, visits, and other departments) into one electronic record. In FY 2013 MUWRP will support;1) the customization of the EMR further and make it complete with fingerprint technology, SMS technology and all modules (HCT, Care and treatment, PMTCT, TB, Family planning, including the other existing modules such as pharmacy, laboratory, appointments) to support linkages initially at the Kayunga District Hospital. 2) In collaboration with MoH Rsource Center, MUWRP will support the roll out of DHIS2 to health center IV level. 3) MUWRP will support the roll out smaller versions of EMR to ART sites with more than 2000 clients oi care. Activity 1 above will contribute to monitoring the COR by strengthening linkages between program areas.

Operations of the above will be undertaken in collaboration with the district HMIS focal persons at health unit and district levels.

MUWRPs SI support for these districts/health units will continue (provision of computers, internet, weekly SI QA/QC supervision etc.) as per the established MUWRP M&E plan. This plan includes rolling out routine M&E to district-based programs, rolling out Continuous Quality Improvement (CQI) at MUWRP supported health units and also contains a provision for training selected health workers in HMIS related areas. In FY 2013, MUWRP will train in SI a total of 50 health workers from the districts of Buvuma, Mukono, and Kayunga. MUWRP will continue to work throughout each of the districts in FY 2013 to offer quarterly off-site supportive supervision, and quarterly review meetings to monitor the submission of reports through the established GoU channels and encourage data use at all levels of service delivery.

Furthermore, MUWRP will assist Kayunga, Mukono and Buvuma districts to roll out the recently revised HMIS tools and to fully adopt the DHIS2, not only at district level, but up to health sub-district level. In an effort to reach out to MARP/underserved populations on Lake Victoria, MUWRP will conduct mapping of hot spots on the Koome and Buvuma Islands in FY 2013.

In FY 2013, MUWRP will support a routine mentorship program at all MUWRP supported health units. The program will make use of district HMIS focal persons, MUWRP M&E staff and clinical staff, to carry out onsite mentorship. The mentorship discussions will be based on results from routine data quality assessments at health units supported by MUWRP and results from Continuous Quality Improvement (CQI) carried out at health unit level.

Funding for Biomedical Prevention: Voluntary Medical Male Circumcision (CIRC): $2,096,239

In FY 2009, MUWRP implemented Uganda's first non-research VMMC program at the Kayunga District Hospital. The program launch included a remodeling of a minor surgical theatre for performing VMMC surgeries. MUWRP developed program policies, procedures and quality assurance guidelines, all in accordance with WHO guidance. Data from the first 315 service recipients was analyzed as part of a basic program evaluation (BPE). The data showed levels of patients very satisfied at > 85%, minor adverse events at < 1%, and zero HIV sero-conversion after one year. After the BPE, MUWRP developed a VMMC ledger tool, which greatly reduced the paperwork burden for clinicians, but still captured all of the WHO-recommended VMMC indicators. In FY 2010, MUWRP launched a second VMMC program at the Kojja Health Center IV, and was mandated to establish a second National VMMC Training Center. Since its establishment, more than 250 clinicians have completed the comprehensive two-week training. Through the training center, MUWRP teaches the implementation of VMMC methods such as the forceps-guided surgical technique, electro-cautery, and the MOVE Model. During FY 2011, in an effort to provide VMMC services to MARP fishing populations along the shores of the Nile River and Lake Victoria, MUWRP designed and implemented a VMMC mobile clinic. MUWRP also launched a third VMMC fixed site at the Mukono Health Center IV in FY 2011. After the launch, MUWRP conducted a VMMC camp which provided safe, comprehensive services to over 1,200 males in two weeks. In FY 2012, the MUWRP VMMC program will continue to safely reach more service recipients, and through its Training Center, will teach innovative staffing and surgical techniques to VMMC service providers. Before and after clinicians are trained, MUWRP staff visit them to confirm that they are an appropriate investment, and that training goals have been realized. To ensure the continued scale up and roll out of VMMC in Uganda, MUWRP will continue to provide VMMC technical support to the MOH and to VMMC technical working groups. Additionally, the MUWRP VMMC training center has drafted a curriculum that will shorten the two-week VMMC training to just one week. Plans are underway to incorporate MUWRPs mobile clinic into a mobile surgical camp setting, using customized tents and collapsible equipment. Using this infrastructure, MUWRP plans to increase mobile services to MARP populations on island communities, as well as to begin conducting satellite and mobile trainings for service providers. MUWRP will continue to provide safe, comprehensive VMMC services, which always include: (1) HIV testing and counseling, (2) pre- and post-operative sexual risk reduction counseling, (3) assessment and/or treatment of STIs, (4) family planning/condom use counseling, (5) counseling pertaining to the need for abstinence from sexual activity during wound healing, (6) wound care instructions, and (7) post-operative clinical assessments and care. Of paramount importance to MUWRP is an efficient program that yields low marginal costs. This is made possible by securing strong buy-in from district and national health officials, as well as religious/opinion/political leaders; and strong messaging, mobilization, and community education components within the program.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $138,000

As part of an expanded MUWRP PEPFAR program in FY 2007, a HIV prevention program was inaugurated, which has coordinated Sexual Prevention Abstinence/Be Faithful (AB) activities in Kayunga district. Since that time, district residents have been routinely exposed to HIV prevention messages promoting abstinence, including the delay of sexual activity or secondary abstinence; fidelity; reducing multiple partners and concurrent partners; and related social and community norms that influence these behaviors. These messages are disseminated through radio, marketplace loudspeakers, standardized IEC materials, posters, eight billboards, weekly drama presentations (including competitions), health fairs, and sporting events. Services have been especially tailored to reach underserved/at-risk youth populations, both those in- and out-of-school, as well as those living in high risk fishing villages along the river Nile and at the inlet to Lake Kioga. MUWRPs (AB) program has trained and supported volunteers and district lay workers, including 1,200 treatment club members, and 70+ dedicated youth volunteers to carry out the AB prevention activities described above. In addition to AB messages, these lay workers concentrate on male norms/behaviors, increasing gender equity, cross generational sex, and increasing womens legal rights and access to income -including life skills as they are related to HIV prevention. MUWRPs AB program additionally supports the infrastructure and activities of a vibrant and well-attended youth center, the Kayunga District Youth Recreation Center (YC). In partnership with the US Peace Corps and the Kayunga Town Council, MUWRP supports the YC to be a place of recreation and education for young people, ensuring that they are provided with an array of health related and life-skill services. In FY 2012, MUWRPs coverage area will significantly expand to include all of Kayunga, Mukono and Buvuma districts. As a result of this, the target population for MUWRPs AB services will dramatically increase and include many more isolated MARP populations on Lake Victoria islands. MUWRPs AB programs for these districts will continue as described above (use of various media, IEC materials, etc.). MUWRP will continue to target in- and out-of-school youth through community and school outreach programs and via the YC (focusing on abstinence-only for those under age 15, and abstinence and faithfulness for age 15-17) . MUWRP plans to utilize the newly built basketball court at the YC to teach AB health promotion through supporting a multi-district basketball league. Human resources for MUWRPs AB program relies on the annual training of peer educators, who start as volunteers at the YC and train to become full-time community outreach workers, under the strict supervision of MUWRPs HIV Prevention QA/QC Coordinator. Under his supervision, all of MUWRP prevention programs are monitored, analyzed, and evaluated to determine if the program has realized its designated goals. Finally, MUWRPs AB program will partner with the ARTIVISTS group in FY 2012. ARTIVISTS are a newly formed group of dynamic young artists from Makerere University who will conduct bi-weekly dance, drama and art sessions with youth throughout the three MUWRP districts. The ARTIVISTS focus on AB messaging, creating different media forms (especially mural messages on buildings), and the reduction of HIV transmission among youth caused by traditional male norms.

Funding for Prevention: HIV Testing and Counseling (HVCT): $579,414

During FY 2011, MUWRP supported comprehensive HTC services for more than 25,000 persons. In FY 2012, MUWRPs coverage area will significantly expand to include all of Kayunga, Mukono and Buvuma districts. As a result of this, the number of persons requiring MUWRP-supported HTC services will double. The program supports the following HTC programs: provider-initiated (routine at all MUWRP supported clinics, including X-ray, dental, and in- and outpatient wards), client-initiated, couples testing, VMMC, PMTCT, and special events/HTC campaigns throughout 40 health units. Special target populations in MUWRPs HTC program include: fishing villages along the River Nile and island communities on Lake Victoria, youth, alcohol users, and CSWs and their partners. The proportional allocation of MUWRP HTC funding to each target area are as follows: VMMC 12%, MARPs 22%, PWP 4%, and Youth 13%, HIV prevalence in the MUWRP catchment area is 6-7%; however, among MARPs it is as high as 27%. Due to sporadic availability of commodities in Uganda, MUWRP always provides supply chain management technical assistance (TA) and back-up commodity supplies to all of the HTC sites/programs. Funds are also used for training, staffing, transportation, supportive supervision, sub-contracts, and ongoing TA in the areas of service delivery. The Uganda MOH HIV testing algorithm (Determine, Stat Pak, and Uni Gold-as a tie-breaker) is employed for all HIV tests. For those few individuals whose results are still inconclusive after undergoing the MOH algorithm, a blood sample is sent to the MUWRP research laboratory in Kampala for an both an ELISA and a Western blot test. This program heavily focuses on strengthening the linkages to HIV clinics, especially for mothers who test HIV+ through PMTCT programs, for TB patients, and for those who tested HIV+ through the recently ended house-to-house HTC program. Program staff routinely return to the homes of individuals who test HIV+ to ensure that they follow up with facility-based care and treatment. MUWRP supports expert patients who trace LTFU patients to their homes, and also supports an active discordant couples group, which meets quarterly, with an emphasis on prevention with positives. For the purposes of quality control, two processes take place monthly within the program: (1) DBS from all clients who test HIV+ as well as from 2% of the HIV- clients are collected and sent to a reference lab for retesting, the results of which are compared with the field results; and (2) quarterly testing of quality control samples prepared in the lab are distributed to the HTC staff and their results are compared with the known results; thus, staff competency is routinely ascertained. Routine monitoring and evaluation of all data from the HTC program have informed program policy at the district level and driven MUWRP program policy to expand program services to clearly identified MARPs, especially fishing communities and youth. Promotional activities to reach all of the HTC target populations include billboard advertising, marketplace announcements, posters, drama presentations, and sporting events. All HTC services, despite the program, are provided by either trained/tested/monitored para-professionals or clinical staff. During FY 2011, MUWRP supported the re-training of 70 HTC staff and eight new staff. Ongoing supportive supervision is provided by a full-time MUWRP HTC technical specialist.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $188,600

As part of an expanded MUWRP PEPFAR program in FY 2007, a formal HIV prevention program was inaugurated, which has provided Kayunga district Other Prevention (OP) activities and coordination. The most important focus of this program has been to ensure 100% condom availability to residents, through coordinated and omnipresent distribution coupled with condom demonstration outreaches. Also since FY 2007, district residents have been routinely exposed to HIV prevention messages and interventions including: sexual and non-sexual HIV transmission, post-exposure prophylaxis (PEP), positive living, reproductive health services, stigma and discrimination, HIV violence and gender issues, traditional male norm issues, and the availability/locations of ART. These messages are disseminated through radio, marketplace loudspeakers, standardized IEC materials, print, posters, eight billboards, weekly drama presentations (including drama competitions), health fairs, and sporting events. Services have been especially tailored to reach underserved/at-risk communities, such as out of school youth and high-risk fishing village youth populations along the river Nile and at the inlet to Lake Kioga. MUWRPs OP program has trained and supported volunteers and lay workers, including 70+ dedicated youth volunteers to carry out the OP prevention activities described above. In addition to OP messages and counseling (one-on-one, or groups < 25), these lay workers concentrate on gender equity, cross generational sex, and increasing womens legal rights and access to income and productive resources as they are related to HIV prevention. In FY 2009, MUWRPs OP program began evening outreach to the specific MARP populations of alcoholics, commercial sex workers and their clients, and bar maids. These outreaches include condom demonstration and distribution. Also beginning in FY 2009, MUWRPs OP program supported the purchase and implementation of incinerators for four health centers. In FY 2012, MUWRPs coverage area will significantly expand to include all of Kayunga, Mukono and Buvuma districts. As a result of this, the target population for MUWRPs OP services will dramatically increase and include many more isolated MARP and transient populations on Lake Victoria islands. MUWRPs OP programs for these districts will continue as described above. As MUWRP expands, efforts will specifically focus on strengthening condom dissemination to ensure that condoms are available at each new health center (levels II, III, and IV), hospital, hotel, bar, police installation, and fishing community. PEP trainings and initiating a PEP referral system for youth and all health centers in the new MUWRP districts will occur in FY 2012. Human resources for MUWRPs OP program relies on the annual training of peer educators, who start as volunteers at the Kayunga District Youth Recreation Center and train to become full-time community outreach workers, under the strict supervision of MUWRPs HIV Prevention QA/QC Coordinator. Under the Coordinators supervision, all MUWRP prevention programs are monitored, analyzed, and evaluated to determine if the program is realizing its designated goals. Finally, MUWRPs OP program will partner with the ARTIVISTS group in FY 2012. ARTIVISTS are a newly formed group of dynamic young artists from Makerere University who will conduct bi-weekly dance, drama and art (three in one) sessions with youth throughout the three MUWRP districts.

Funding for Treatment: Adult Treatment (HTXS): $471,661

MUWRP will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. MUWRP will enroll at least 7149 new clients and support 9149 adults and children on ART by APR 2013, contributing to overall national and PEPFAR target of 190,804 new clients and 490,028 individuals current on treatment. This target is not a ceiling, allowing for higher achievements with continued program efficiencies. Priority will be given to enrolment of HIV positive pregnant women, TB/HIV patients, and key populations. MUWRP will support three districts in Uganda: Kayunga, Mukono and Buvuma (an island in lake victoria)

MUWRP will support the MoH roll out of Option B+ for eMTCT through the following activities: accreditation of 20 additional health facilities; training, mentorship and joint PMTCT/ART support supervision. MUWRP will also support ART/PMTCT integration at facility level piloting feasible service delivery models, such as same day integrated HIV clinics.Continuum of response linkages and referrals will be strengthened using linkage facilitators across different service points in facilities and communities. Facilitators will also be utilized for TB/HIV integration to ensure early ART initiation for TB/HIV patients. MUWRP will support RH integration including family planning and cervical cancer screening at facility level through provision of the services or referrals.Targeted community outreaches in high prevalence hard to reach and underserved areas of Buvuma Island will be conducted. MUWRP will also target key populations using innovative approaches including setting up specialized services; such as moonlight services.

MUWRP will support one HAART clinic for MSMs in Kampala

MUWRP will implement quality improvement initiatives for the ART framework: early initiation of ART eligible clients on treatment; improve adherence and retention; and monitor treatment outcomes. Use of innovative, low cost approaches for adherence, retention and follow up such as: phone/SMS reminders, appointment registers, alert stickers will be supported.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. MUWRP 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.

MUWRP will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, liaise with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). MUWRP will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities.In addition, MUWRP will work with USG partners and other key stakeholders for provision of required wrap around services.The program will be aligned to the National Strategic Plan for HIV/AID (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. MUWRP will work under the guidance of MoH AIDS Control Program and Quality Assurance Department in trainings, ART/PMTCT mentorship and support supervision.

Funding for Treatment: Pediatric Treatment (PDTX): $66,093

MUWRP will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. MUWRP will enroll at least 643 new HIV positive children and support 1832 children on ART by APR 2013. This will contribute to overall national and PEPFAR target of 39,799 new clients and 64,072 children current on treatment. MUWRP will support three districts: Kayunga, Mukono and Buvuma (an island in lake victoria)IN FY13, MUWRP support to the national program 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 under 2 years in line with the national treatment guidelines.

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

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

In addition, MUWRP 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. MUWRP will collaborate with UNICEF and other key stakeholders at all levels for provision of required wrap around services.The program will be aligned to the National Strategic Plan for HIV/AID (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. MUWRP will work under the guidance of MoH/ AIDS Control Program and Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework and support supervision.Funding has been provided to support the recruitment of 00 additional staff in the districts to meet the achievement of the targets. This will be done working with the Health Systems Strengthening technical working group.

Subpartners Total: $0
Makerere University: NA
Cross Cutting Budget Categories and Known Amounts Total: $1,468,000
enumerations.Construction/Renovation $409,000
Economic Strengthening $152,000
Education $83,000
Food and Nutrition: Commodities $98,000
Food and Nutrition: Policy, Tools, and Service Delivery $24,000
Gender: Reducing Violence and Coercion $88,000
Human Resources for Health $581,000
Water $33,000
Key Issues Identified in Mechanism
Addressing male norms and behaviors
enumerations.Impact/End-of-Program Evaluation
Increasing gender equity in HIV/AIDS activities and services
Increasing women's access to income and productive resources
enumerations.Malaria (PMI)
Child Survival Activities
Mobile Populations
Safe Motherhood
Tuberculosis
Family Planning