This mechanism ended on 30th September 2012 and received a cost extension of six months from April September 2012 using COP 12 funding to complete activities and bridge the gap until the new mechanism could be awarded in October 2012. Baylor College of Medicine Childrens Foundation-Uganda (Baylor-Uganda) provided family centered pediatric HIV/AIDS prevention, care and treatment services, health professional training and clinical research in Uganda, operating from Mulago Pediatric Infectious Diseases Clinic. Expansion of National Pediatric HIV/AIDS Prevention, Care and Treatment Services and Training of Service Providers

Under this cost extension, Baylor-Uganda was funded to support comprehensive family-centered HIV care and treatment to over 37,000 HIV infected persons, 7,793 of whom were children less than 15. Cumulatively 141 health facilities in 40 districts across the country had been supported over the project period. Over the previous years, 5,078 health professionals had been trained in various HIV service delivery related aspects.

During FY 2012, Baylor-Ugandas cost extension was planned to provide comprehensive HIV/AIDS services in the districts of: Kamwenge, Kasese, Kabarole, Kyegegwa, Kyenjojo, Bundibugyo, Ntoroko, Kampala and Kiryandongo with an estimated population of 2,250,563 people and an overall HIV prevalence of 8%, covering 70 health facilities.

Baylor-Uganda planned to provide sub grants to the districts, based on plans developed with all stakeholders. Performance-based funding was planned to ensure efficiency and effectiveness in utilizing funds. Performance Monitoring Plans were developed to be implemented to measure the planned activities.

The Baylor program planned to continue supporting the MoH/ACP to achieve its goal of universal access for care and support services (80% by 2015). Adult care and support services comprise facility-based and home or community-based activities for HIV-infected adults aimed at extending and optimizing quality of life from the time of diagnosis throughout the continuum of illness, through provision of clinical, psychological, social, spiritual, and prevention services including positive, health, dignity and prevention (PHDP)services.The project will provide care and support services in districts including facility-based and home or community-based activities for HIV-infected adults and their families aimed at extending and optimizing quality of life for HIV-infected clients and their families throughout the continuum of illness through provision of clinical, psychological, spiritual, social, and prevention services.

The project is maintaining 26,575 adults in care providing cotrimoxazole and other care and support services. The program planned to increase the number of patients in care to 32,000 adults with planned activities including purchase of OI medicines for adults at Mulago clinic and a buffer for district health facilities towards improving the quality of care for HIV+ clients including voluntary family planning services; STI screening and treatment; and cervical cancer screening and management.

The project planned to support PHDP services for improving HIV care and HIV prevention (including partner testing, counseling, OI management, pain assessment and management, STI management and condom distribution, nutritional information, TB prevention, alcohol abuse and drug adherence) as well as support procurement and distribution of safe water systems, cotrimoxazole, and malaria prevention. The program planned to conduct one five-day training for district health facility staff in cervical cancer screening and STI management, conduct two five-day trainings of district health workers on quality improvement, conduct one three-day Training-of-Trainers session for district health workers on quality improvement (QI), conduct QI mentorships/coaching visits to selected health facilities by Regional and District mentors targeting five health workers per facility and conduct two technical support visits to 14 selected facilities by the central QI team.

This program would support procurement of basic care kits quarterly for clients in upcountry supported health facilities.

In order to enforce adherence to standards, two-day review meetings for the Home Based Care program in district health facilities twice a year was planned. The project would support health facilities in data capture, management and reporting through hands on capacity building and training for staff, as well as supporting commodity quantifications and requisitions from National Medical Stores and Joint Medical Stores.

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

Previously Baylor-Uganda scaled up access to OVC services through training of 30 OVC providers in Kasese district, integration of Child protection into clinic activities, provision of scholastic materials to 50 children in Kyenjonjo district and provided school fees to 80 OVCs at the Center of Excellence (CoE), and provided a revolving fund to two groups each benefiting 50 OVC families.

In the 2011/2012, Baylor-Uganda planned to carry out the following activities:

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

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

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

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

Purchase and distribution of 10 sets of play therapy materials to seven districts health facilities, also planned to organize and facilitate Caretakers Drama Group of 20 members for community awareness raising and sensitizations at the CoE. Training in marital and family counseling to 18 counselors would be conducted, monthly VCT outreach to OVC dwelling places, orphanages and babies homes, know your childs HIV status campaign would be conducted and children needing psychosocial support would be identified and followed up.

This project planned to implement the MOH TB/HIV policy through the structures of the National TB and Leprosy Control Program. Interventions to decrease the burden of TB among PLHA (Intensified TB case finding-ICF, Isoniazid prevention therapy, and Infection control) and HIV among TB patients (PITC, CPT and ART for TB/HIV co-infected patients) would be supported. TB screening was planned to be integrated at all service points. Supplies for TB commodities like tuberculin skin tests and X-ray services would be supported. Health care workers planned for training in TB screening and TB/HIV management. Surveillance for MDR TB through sputum cultures would be supported.

In this program area, Baylor planned to carry out the following key activities:

To ensure patient monitoring, the project would procure and distribute six vials for Purified Protein Derivative (PPD) for each of the 70 supported health facilities per quarter and 16 vials of PPD for the Center of Excellence per month for TB screening and also conduct chest x-rays for 40 patients at Mulago PIDC per month and 100 patients from upcountry supported health facilities per month.

Baylor-Uganda planned to conduct sputum microscopy for 40 suspected TB in HIV clients at Mulago Pediatric Infectious Disease Center (PIDC) per month and facilitate referral of 100 sputum samples in 10 health facilities for culture and Drug Sensitivity Testing (DST) in supported Health Facilities. In addition, the program will improve information processing and communication, the program planned to procure seven desktop computers for District TB/Leprosy Supervisors (DTLS).

Conduct orientation training in TB/HIV collaborative activities for facility TB/leprosy/HIV focal Persons in which 30 participants would be trained. Provide buffer stock of drugs for TB treatment and prophylaxis aimed at treating 805 patients with anti-TB drugs a year, 400 clients receiving INH prophylaxis a year and patients on second line HAART are treated with Rifabutin at Mulago PIDC in a year.

Facilitate 20 Sub-county health workers (SCHWs) and facility TB Focal Persons to conduct TB contact and defaulter tracing aimed at conducting 480 contacts tracing outreaches per year. The project would facilitate DTLS to conduct quarterly support supervision of TB/leprosy/HIV services in the district and facilitate 20 DTLS to conduct at least 20 monthly supervisory visits to of SCHWs in the district.

Baylor-Uganda also planned to support MOH to reproduce and supply MoH TB/HIV job aides and IEC materials on TB to district health facilities. Continue to support TB/HIV collaborative activities, providing HIV testing for TB diagnosed patients and TB screening for HIV+ clients and support and strengthen health facilities in the TB three Is implementation.

The project was funded for the extended period to support districts and health facilities to provide quality pediatric HIV care. Health workers were to be re-oriented and supported to provide clients with co-trimoxazole, opportunistic-infection (OI) management, CD4 monitoring, and other care services. Health facilities were to support ongoing counseling to children and their caretakers, and to ensure patient follow up and community linkages are strengthened.

The project planned to provide care and support services in 8 districts. At the time, the proportion of children in care was 21% at the Center of Excellence (COE) and Rwenzori region but the COE had 80% of its clinic population as children and Rwenzori has 9.5%. The program planned to increase the proportion of patients in care who are children from 9.5% to 15% in the Rwenzori region in line with the national target.

In order to achieve this, Baylor Uganda proposed to support districts and health facilities to forecast, procure and provide OI drugs for children and adult caregivers in all supported health facilities. It also planned to facilitate eight supported districts to conduct monthly integrated MCH/HIV care outreaches in all facilities to improve care linkages for all clients in supported facilities.

Baylor Uganda planned to support adolescent client peer support activities; provide psychosocial, spiritual services; and support health workers in various facilities to improve care for children through capacity building and skills development as well as providing educational materials, procure and distribute job aides on pediatric HIV prevention, care and support and nutrition to all supported health facilities in the districts.

Mentorships and support supervision were to be conducted in supported health facilities in order to improve care. Village Health Teams (VHT) would be used to follow up patients and support facility-community linkages to improve retention in care and reduce loss to follow up. This would be integrated into other VHT activities that contribute to improving the general health hence contributing to the principles of the U.S. Global Health Initiative.

The program planned to improve linkages to care and treatment and follow up of mothers and babies for delivery of EID results and continued care and support for the children. Baylor Uganda planned to procure and distribute Plumpy-Nut nutritional supplement to support 300 malnourished children in selected district facilities.

The project planned to provide buffer stock of drugs and supplies to district health facilities including procurement and distribution of safe water systems, cotrimoxazole for prophylaxis, malaria prevention, condom distribution, and family planning information and commodities. Baylor Uganda would follow up and link children/households with psychosocial needs and food support respectively to other providers.

The program planned to support adolescents and their transition into adult life through support groups, adherence support and counseling. These activities would engage adult caretakers into the transition process while integrating with sexual and reproductive health activities.

Baylor Uganda planned to support positive health, dignity and prevention services for adolescents including counseling, OI management, and pain assessment and management, STI management, nutritional care and support.

Baylor-Uganda planned to support the development and strengthening of laboratory systems and facilities to support HIV/AIDS-related activities including: strengthening of laboratory leadership and management; purchase of equipment and buffer stock including other laboratory commodities; strengthening of laboratory supply and equipment management systems; promotion of quality management systems, laboratory monitoring and evaluation, and laboratory information systems; and the provision of staff training and other technical assistance.

QA/QC activities would be supported by the program and using PEPFAR II indicators for measuring quality in laboratory services would provide critical information for more accurate forecasting, planning and budgeting for laboratory support for program activities.

All supported facilities at level III Health Centers (HC) would be facilitated to have a laboratory with capacity at its level. Training activities were developed focusing on laboratory management and quality assurance of laboratory testing.

The following were the planned activities;

The program intended to refurbish Bundibugyo, Bukuku and Kyenjojo health facilities and labs to improve the care environment for patients. Planned to install and maintain CD4 machines at Kibiito HC IV and Kyegegwa HC IV to support patient monitoring in the region.

Support transportation of laboratory samples (DBS, CD4, CBC and sputum) to testing labs and return of results was planned for support by the program. Regional laboratory hubs would be utilized in DBS transportation to the Central Public Health Laboratory (CPHL).

Supporting and facilitating village health teams, volunteers and peer mothers to follow-up the baby-mother pairs and missing clients was planned for.

Baylor-Uganda planned to link with CPHL to conduct training and mentorship for Kilembe Mines Hospital through the Strengthening Laboratory Management towards Accreditation (SLMTA) program to support its accreditation. CPHL would also be contacted to support laboratory materials and other trainings.

Baylor-Uganda planned to procure two Partec CD4 machines, two laboratory fridges, and their respective reagents and also conduct laboratory monitoring of patients in care and treatment in district health facilities aiming at 80% of clients accessing general laboratory tests for monitoring, 6 monthly CD4 and CBC tests per clients and other relevant tests for drug toxicity depending on the each client's needs.

1.Baylor-Uganda has been able to strengthen organizational and build the technical capacities of districts to plan and manage comprehensive HIV/AIDS services by:

Providing performance based sub grants to districts, supporting recruitment of critical missing cadres for health facilities, introducing and operating laboratory hubs (COE, Ntara, Buhinga and Kilembe mines) and mapping health facilities to them. This has improved DBS, CD4 count and CBC access in the districts and reduced turnaround time for results from two months to two weeks, strengthening logistics and supply chain management of HIV/AIDs commodities by training and mentoring 62 health workers and provision of buffer stocks. Stock-out of basic commodities reduced from 65% to 16.7% and training and mentoring health workers in HIV/AIDs/TB and M&E skills.

For this extended period Baylor-Uganda planned to:

Support recruitment of key cadres in the target districts to support provision of comprehensive HIV comprehensive services through district sub grants and train health facility staff in HIV/AIDs services provision (PMTCT/EID, RCT, Pediatric HIV Care) in supported districts.

Support mentorships and technical support visits to health facilities monthly and quarterly respectively would be conducted to build skills and ensure sustainability of provision of adult and pediatric HIV care and treatment services. Planned to build capacity of regional and district mentors in HIV/AIDS technical support supervision to ensure continuity of services in supported health facilities at district level. District work plans and budgets would be supported through performance based sub grants and the project will procure CD4 machines for Kyegegwa HC IV and Kibiito HC IV to support this underserved region. The machines were expected to lead to sustainability of the services since these services were provided by the COE in Kampala.

Under this program area we planned to increase coverage and utilization of provider-initiated testing and counseling (PITC) services within health facilities in eight target districts. With project technical and logistical support, health facilities would integrate PITC including early infant diagnosis (EID) at all service delivery points. Each consenting HIV-positive client would be assigned a Village Health Team (VHT) member of their choice for follow up and support. Index HIV positive clients would form the basis for family-based HIV counseling and testing (HCT).

A total of 84,331 people were tested for HIV between October 2010 and June 2011 compared to 57,613 tested between Oct 2009 and Sept 2010. In this period the program planned to test 180,013 individuals and continue supporting health facilities through the bi-annual "know your childs status" campaigns in supported health facilities, support districts to conduct monthly HCT community outreaches by health facilities prioritizing most-at-risk populations and support districts and health facilities to procure supplies for conducting home visits/patient follow-up to provide community-based HIV counseling and testing (CBHCT) services.

The project planned to support health facilities to provide PITC at outpatient clinics and in-patient wards for all clients coming for care at any care point in the facilities and to support facilities to conduct outreaches among MARPs. The project planned to conduct two 10-day pediatric HIV/AIDS counseling training in Rwenzori region and conduct five three-day trainings for community volunteers on CBHCT.

Uganda has adopted Option B+ for all HIV-positive pregnant women, therefore the following PMTCT services would be offered: training of health care workers to provide Option B+ as opposed to previous Options A and B, follow up of women to ensure adherence, partner involvement, ensuring facility delivery, laboratory monitoring and post-natal services including infant feeding.

Baylor-Uganda planned to expand coverage and utilization of PMTCT services so as to achieve virtual elimination of MTCT in the target districts and the interventions would use the four-pronged strategic approach to PMTCT.

Baylor-Uganda expanded coverage of PMTCT services from 12 to 70 health facilities and thus increased the number of clients accessing PMTCT services from 1,756 in 2010 to 68,034 in 2011. Baylor plans to expand provision of PMTCT services in the 8 supported districts, covering 100% of Health Centre IIIs, covering 90 health facilities, and reaching 119,400 pregnant women by implementing the following activities.

The program planned to procure and distribute 4,000 Mama Kits and 74 delivery kits in the eight districts and more than 3,000 Mama Kits and 100 delivery kits have been budgeted under the Saving Mothers, Giving Life project to support the region. This is leveraging funding from other USG-funded projects. Also planned is procurement of 165 delivery kits for health facilities in each of the eight districts, procurement of 10 ward screens, and support to MOH to reproduce and distribute PMTCT/EID HMIS tools.

Under each prong the following will be done:

The project planned to support radio talk shows in the region focusing on prevention and to train VHTs to carry out household sensitization for prevention of HIV. The project planned to train 60 health workers and volunteers in PICT and also support HCT outreaches by facilities through sub-granting.

The project will support health facilities to provide counseling to HIV infected women and family planning services. Modern long term methods of family planning would be availed in supported health facilities through leveraging government and other donor support. The program planned to provide cervical cancer screening services to HIV infected women.

Different trainings were planned for health workers in supported health facilities in the eight districts. These trainings include PMTCT-EID, TOT, HCT, VHT and logistics management. The project plans to provide technical support supervision through mentorship in all supported health facilities, reproduce and distribute PMTCT/EID/HMIS tools, and facilitate CD4 sample transportation. The project would facilitate follow up of mother-baby pairs by peer mothers through district sub-granting and support initiation on ART for all HIV+ women for life and exposed babies on NVP for six weeks from birth following the planned MoH transitioning schedule.

The project planned to establish effective referral systems for HIV-infected mothers and HIV-exposed or infected babies for enrollment into HIV care and treatment. The project planned to support VHTs follow up of pregnant mothers and exposed children in the community. Ongoing care and support services including counseling, cotrimoxazole prophylaxis and STI management would be provided at all care and treatment sites for clients to improve retention and quality of care. The program planned to work with other USG implementing partners (e.g. SUSTAIN) to implement its activities.

Baylor-Uganda receives ARV drugs from the Clinton Foundation although the support for this has ended for adults in December 2011. The program was supporting 4,485 patients at the Center of Excellence (CoE) in Kampala and 6,280 patients were served in Private not-for Profits (PHFPs). Sixty-six public health facilities will need a buffer of ARVs. Six percent of the patients on ART are on second-line treatment.

Baylor-Uganda planned to provide ARV for facilities, the CoE and PNFPs in the supported districts, train health facility staff in HIV/AIDS logistics and supplies management to minimize stock out of drugs and improve forecasting, ordering and reporting.

The refurbishment of drug stores and records rooms was planned for; procurement of first line ARVs for children at the Pediatric Infectious Disease Center (PIDC), procurement of the second line ARVs for children at PIDC and procurement of ARVs for PMTCT (Option B) would be done. The program would also procure ARVs for children and adults for PEP. Drug procurement will be done through the logistics mechanism, Medical Access Uganda Limited (MAUL).

District based MoH facilities were included when planning for buffer ARV drugs in cases of stock outs.

The Baylor-Uganda program is committed to supporting the MoH achieve its objective of universal access to ART of 80% of eligible clients by 2015. Under this program infrastructure development, training of clinicians and other services providers, clinical examination of adult patients, clinical monitoring, laboratory service, and community-adherence activities including clinical monitoring and management of opportunistic infections would be the priority focus.

For adult treatment Baylor-Uganda will carry out the following activities:

Ensure that all clients on ART receive CD4 testing every six months to monitor progress on treatment. Clients would be provided with cotrimoxazole and other basic care commodities working in line with PACE for procurement and distribution. The program would also procure ARVs for buffer for the district based facilities and Center of Excellence from Medical Access Uganda Limited (MAUL). Clients would also be provided with positive health, dignity and prevention services including sexual and reproductive health, voluntary family planning, STI management and re-enforcement of positive prevention messages.

Community based HIV counseling and testing, monthly review and planning meetings at Mulago will be conducted, training of district teams in supportive supervision and leadership for HIV/AIDS services would be done and districts would be supported to conduct quarterly supportive supervision of district health care and treatment services. This would help link clients identified from HCT immediately into care for ART eligibility assessment and treatment initiation for the eligible reducing on waiting time and loss to follow up.

Using the VHTs and other peer support and expert clients, clients would he supported to adhere to their medications and retained on treatment. These support groups are planned to be used in client follow up to address and reduce on loss to follow up.

Baylor-Uganda planned to participate in annual health planning workshops of supported districts, conduct bi-annual regional program review and planning workshops.

Baylor-Uganda would support storage and transportation for ARV drugs and laboratory supplies and distribution to supported health facilities. Train clinical service providers in adult HIV treatment and monitor patient adherence to treatment and performance of other clinical outcomes.

In offering support the program planned to work with other providers in the region e.g. USG funded SUSTAIN, UEC, UPMB to provide coordinated and quality services and reducing on duplications and overlap.

Baylor-Uganda planned to support districts and facilities to provide quality treatment, with special attention to pediatric and adolescent services. Staff would be re-oriented and supported with job aides to help assess patients for ART eligibility and initiate patients on ART. Staff would be supported to ensure quality patient monitoring and management of complications of ART according to MoH guidelines. Planned to support facilities offer ongoing counseling, and to ensure patient follow up and community linkages to foster adherence and retention on ART treatment.

Baylor-Uganda planned to carry out the following activities in order to increase access and utilization of pediatric treatmentConduct two-day technical support supervision to 70 supported health facilities that have completed mentorship once every six months.

Procure regional office basic office machines, equipments, rental services and refurbish 10 district health facilities-HIV/AIDS clinics and laboratories and conduct two, five-day regional level training workshops for health workers in pediatric HIV management. The program would carry out bi-annual technical support supervision of 33 districts in NEP where Baylor has exited, three days per district. Development and dissemination of messages on HIV/AIDs care and treatment on three radio stations in the Rwenzori region and reproduce and distribute IEC and HIMS materials was planned for.

Baylor-Uganda planned to procure and install laboratory testing equipments in Kyegegwa HCIV, procure fridges for storage of Kaletra and other ARVs for 15 health facilities that have power and procure machines/materials to support project M&E in the district health facilities.

Support monitoring of ARV toxicity in district laboratories and bi-annual CD4 monitoring would be done for all patients. Baylor-Uganda shall conduct two, five-day pediatric and adult HIV management training and two, three-day logistics training for HIV/AIDS commodities in the Rwenzori region.