The AIDS Support Organization (TASO) was funded for a cost extension period of six months from April 2012 to Sept 2012 to provide HIV services in 11 service centers and 23 public health facilities in 11 districts in Uganda including: Masindi, Gulu, Soroti, Mbale, Tororo, Wakiso, Rukungiri, Masaka, Mbarara, Jinja and Kampala.

The program proposed to provide primary HIV prevention services through confidential testing to partners and children from TASOs HIV positive index clients, and scale up of Provider Initiated Testing and Counseling (PITC) in the public health facilities, provide PMTCT services to HIV positive pregnant women and refer them for antenatal services, provide care, support and treatment to all eligible clients. TASO planned to distribute condoms both at the facilities and in the communities where the drama groups would make performances for HIV Testing Counseling (HTC) campaigns.

TASO proposed to provide a comprehensive HIV care and treatment package linked to TB management, prevention of opportunistic infections and prevention and management of STIs. Adequate human resource capacity for HIV prevention, care and treatment would be developed. The program would facilitate referrals for services not available at its sites to hospitals. All clients in care would be screened for TB and treatment would be provided to those diagnosed. TASO planned to transition outreach services to in-facility services to enhance health system strengthening and all data collection would be done with use of MoH tools. TASO planned to focus on HIV combination prevention interventions at all the supported facilities.

The program will not procure new vehicles but would maintain existing fleet during this period.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Principal Recipient3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesOHSS Selected civil society organizations 1339371 Training service providers in HIV prevention $903,007; IEC materials for HIV prevention $291,364; Procurement of computers $145,000

TASO proposed to provide high quality counseling services as one of the key components of care, treatment and support services. Counseling would aim at empowering HIV infected and affected persons to make informed decisions that improve their quality of life. The program would provide care to over 90,063 clients. All clients would have biannual CD4 testing; the Pre-ART clients would be assessed for ART eligibility in order for them to be initiated on treatment early according to the national treatment guidelines and the ART clients for monitoring treatment outcome.

Medical teams would follow up clients guided by the appointments management system. Complicated cases would be referred for specialist attention. Clients diagnosed with STIs and their partners would be treated. Among others, clients would be educated on correct and consistent condom use and provided with condom supplies.

TASO would coordinate with PACE for provision of Mosquito bed nets and the basic care kit for clients in care. All clients and their family members would be sensitized on malaria prevention and those presenting with malaria signs and symptoms will be tested and the diagnosed would be treated.

TASO planned to screen all clients in care for TB and all TB patients would be offered HIV Testing and Counseling (HTC) and the identified positives would be linked to care. All those diagnosed with TB would be treated. Follow up of patients will be done through clinic and home visits conducted by a TASO staff, Village Health Teams (VHT) or other community volunteers.

Standardized treatment, based on MoH guidelines would be used including standardized and short-course regimens of fixed- dose drug combinations. TASO would work with the district health offices to ensure effective TB drug supply and management system including an M&E system that utilizes the national TB register as the primary data collection tool. All TB/HIV patients once stable regardless of CD4 count will be initiated on ART according to the national treatment guidelines. A total of 131,848 clients would be screened for TB and 2,000 would be treated for TB in FY 2012.

TASO would contribute to addressing the threat of Multi-Drug Resistant TB (MDR-TB) and other challenges through implementing collaborative TB/HIV activities including: collaboration with the National TB/Leprosy control program and Uganda Stop TB Partnership (USTP) for which TASO is a member, reducing the burden of TB in PLHIV through intensified case finding at all service points and their households members; referral between HIV and TB services. TASO would contribute to Health System Strengthening by working with VHTs to develop their capacity to manage TB.

TASO proposed to scale up pediatric HIV care services in all the supported health service outlets including the public health facilities, by training health workers and utilizing the services of Village Health Teams (VHT) who are directly involved with the communities to encourage parents and care takers to bring in children who were/or suspected to have been exposed to HIV. This would increase the number of children tested and identified with HIV infection in the facilities. The program would participate in National Child Health Days and establish Early Infant Diagnosis (EID) care points with EID focal persons who would actively link the identified children into care and treatment, in an effort to get as many children as possible. With all these efforts, TASO would have a total of 13,157 children in care.

Counselors would provide up-to-date information on HIV prevention with emphasis on safe infant feeding practices as recommended in the national guidelines, nutrition, cotrimoxazole prophylaxis, tuberculosis control and management and the importance of drinking and using safe water.

Retention in care would be strengthened by use of VHTs, expert clients, peers, community nurses and field officers. Adolescent health, ART adherence and reproductive issues will be addressed at each service outlet by encouraging peer to peer group discussions.

Children with OIs would be treated and complicated cases would be referred. Cotrimoxazole prophylaxis would be provided to all children including exposed infants.

TASO laboratories meet PEPFAR II indicators for quality in laboratory services. Training of laboratory staff will continue and all staff will be certified in Good Clinical and Laboratory Practice (GCLP) in the first half of 2012. TASO Headquarters will: ensure functionality of laboratories. Each TASO Laboratory has a Lead Laboratory Technologist who is the Manager of the Laboratory and ensures that the Laboratory is working in accordance with GCLP. The Lead Laboratory Technologist will continue to ensure that Laboratory tests meet quality standards and equipment is regularly serviced and re-calibrated to ensure quality and reliability of test results.

TASO has 12 functioning Laboratories. They have designated areas for testing, storage and archive facilities. The Laboratories have necessary infrastructure, qualified personnel and equipment. TASO Laboratories will access DNA PCR testing and Viral Load (VL) through the program by MoH to centrally perform DNA PCR HIV testing at Central Public Health Laboratories (CPHL).

TASO has a Stores Information System (SIS) and Clinical Laboratory System (CLABS) linked to TASO database. All purchases and utilization are tracked and SIS generates consumption reports and projections. CLABS generates reports to aid planning and forecasting.

A curriculum to be used to train Laboratory personnel in GCLP, utilization of laboratory equipment, TB Sputum microscopy, CLABS, Laboratory safety and waste management will be developed and this will strengthen laboratory personnel in laboratory management and assurance of laboratory testing. TASO laboratories participate in both internal and external quality assurance schemes. For CD4 testing. TASO Laboratories participate in the United Kingdom National External Quality Assessment Service (UK NEQAS) for microbiology and for TB; TASO Laboratories participate in the National TB and Leprosy Program for sputum microscopy.

TASO will collaborate with CPHL through District Laboratory Focal Persons (DLFP) to ensure coordinated trainings of Laboratory personnel. TASO will strengthen Laboratories at health units and train health workers to perform rapid HIV testing, blood sample collection for ART monitoring, GCLP, planning/budgeting and referrals to ensure safe shipment of samples. TASO will conduct joint support supervision with the DLFP ensure quality of Laboratory services and monitor using an appropriate tool to ensure that health facility Laboratories qualify for accreditation.

HIV Testing and Counseling (HTC) is an entry point to HIV prevention, care and treatment services. Knowledge of HIV sero status is a pre-requisite for access to effective HIV interventions that reduce morbidity, mortality and HIV incidence. TASO provides HTC to family members of clients and the general population. TASO continues to offer HTC to family members of its index clients as a strategy to reach out to their partners. TASO also provides re-testing opportunities for those in discordant relationships. In the past 12 months, TASO provided HTC to 13,466 people using home visits and the outreach model. Of this number, 542 were children under five years, 2,860 young people aged 5 -17 years and 10,064 adults aged 18 and above; 776 couples were reached with HTC and risk reduction messages in various communities. The prevalence of HIV in this population was similar to the former national average of 6.4%.

TASO planned to reach out to key populations including fisher folks, Commercial Sex Workers (CSW), men who have sex with men and men and women in uniform with HTC services during special events including center annual meetings, candle light days, Every Body Wins campaigns and on international AIDS day. Other Populations reached include youth and prisoners. All people that tested positive were linked to care through referral to TASO or their preferred choice of facility.

In FY 2012, TASO would strengthen efforts to provide HTC services to 30,000 individuals. The services would be offered at all TASO supported sites and surrounding districts. HTC would target couples and MARPs with specific focus on CSWs, uniformed services, fisher folks and prisoners. TASO would ensure delivery of combination HIV prevention interventions to all populations reached. TASO drama groups through music dance and drama skits would mobilize communities for HTC services. Information disseminated would include abstinence, PMTCT, condom use, family planning, referral for Voluntary Medical Male Circumcision, STI management and SGBV. Those that test positive would be linked to HIV care and support services either to TASO supported sites or other service providers of preference. In addition linkages would be made with other partners that offer services for VMMC, STI management and other services to ensure an effective referral system. TASO would follow up those that have been referred to ensure they access the service they require.

TASO would offer HTC services in line with the MoH HTC policy. Supportive supervision would be conducted to all service delivery units with respective local district government and partners to sites on a quarterly basis. Quality control would be done to ensure results given are accurate and reliable through use of Standard Operating Procedures, quality testing kits, and sending samples for proficiency testing to reference laboratories.

HIV Testing and Counseling (HTC) is an entry point to HIV prevention, care and treatment services. Knowledge of HIV sero status is a pre-requisite for access to effective HIV interventions that reduce morbidity, mortality and HIV incidence. TASO provides HTC to family members of clients and the general population. TASO continues to offer HTC to family members of its index clients as a strategy to reach out to their partners. TASO also provides re-testing opportunities for those in discordant relationships. In the past 12 months, TASO provided HTC to 13,466 people using home visits and the outreach model. Of this number, 542 were children under five years, 2,860 young people aged 5 -17 years and 10,064 adults aged 18 and above; 776 couples were reached with HTC and risk reduction messages in various communities. The prevalence of HIV in this population was similar to the former national average of 6.4%.

TASO planned to reach out to key populations including fisher folks, Commercial Sex Workers (CSW), men who have sex with men and men and women in uniform with HTC services during special events including center annual meetings, candle light days, Every Body Wins campaigns and on international AIDS day. Other Populations reached include youth and prisoners. All people that tested positive were linked to care through referral to TASO or their preferred choice of facility.

In FY 2012, TASO would strengthen efforts to provide HTC services to 30,000 individuals. The services would be offered at all TASO supported sites and surrounding districts. HTC would target couples and MARPs with specific focus on CSWs, uniformed services, fisher folks and prisoners. TASO would ensure delivery of combination HIV prevention interventions to all populations reached. TASO drama groups through music dance and drama skits would mobilize communities for HTC services. Information disseminated would include abstinence, PMTCT, condom use, family planning, referral for Voluntary Medical Male Circumcision, STI management and SGBV. Those that test positive would be linked to HIV care and support services either to TASO supported sites or other service providers of preference. In addition linkages would be made with other partners that offer services for VMMC, STI management and other services to ensure an effective referral system. TASO would follow up those that have been referred to ensure they access the service they require.

TASO would offer HTC services in line with the MoH HTC policy. Supportive supervision would be conducted to all service delivery units with respective local district government and partners to sites on a quarterly basis. Quality control would be done to ensure results given are accurate and reliable through use of Standard Operating Procedures, quality testing kits, and sending samples for proficiency testing to reference laboratories.

ARV procurement for the existing TASO patients. Funds were provided TASO to provide a funding coverage until the new ARV procurement mechanisms were put in place.

TASO has two types of service delivery models facility and community based. All patients are initiated in the facilities; however, once stable they are transitioned to the community model which has a community drug distribution point (CDDP) which serves up to 70% in order to free up space for the very sick and the new enrolments. The community workers include a field supervisor, community nurse, counselor, laboratory assistant and expert clients. These provide all the services and ensure adherence to treatment. These CDDP are close to the clients homes and ensures easy drug pick up and adherence. This effort has enabled TASO to achieve more >90% of clients having > 95% adherence levels to ART. TASO would initiate 5,493 clients on ART and would continue to support 46,502 clients on ART at all supported sites in FY 2012.

All clients on ART will have CD4 monitoring every six months and about 3% of patients with suspected treatment failure will a viral load test done.

TASO will build the capacity of staff in pediatric HIV/AIDS care through training and logistics support in all the supported sites. The program will scale up pediatric patients on ART from the current 7% in FY 2011 to 9%. TASO will support ART adherence in children through regular counseling at all supported sites, and in the communities. Use of treatment companions and community sensitization through Village Health Teams (VHT) to map out the children on ART will be encouraged. The VHTs will visit the children, provide psychosocial support and refer children on ART for other services as needed. TASO will support the Early Infant Diagnosis (EID) transportation network and 550 identified HIV positive infants will traced and initiated on ART. All children on ART will have biannual CD4 monitoring.

The program will initiate 1,380 children on ART and will have 5,493 current on ART.