The overall goal of the project Strengthening HIV Prevention, Care and Treatment among Prisoners and prison staff is to improve the health status of prisoners, staff and their families by strengthening the capacity of Uganda Prisons Services to provide comprehensive prevention, treatment, care, and support services for HIV/AIDS and related OIs, STDs, TB and malaria - equivalent to those available in the community and consistent with national polices within five years. specific objectives are:

1.To document HIV/STD/TB prevalence, incidence and the related risky behaviors among prisoners and staff to inform health planning and services delivery.2.To promote HIV prevention strategies for the prisons community.3.To provide comprehensive HIV/STD/TB continuum of care including HCT, clinical care, social support.4.To develop and strengthen HIV/AIDS policies, operational guidelines and administrative instructions for the UPS.

In order to reach out to the annual turnover population of approximately 100,000 prisoners entering prisons; Uganda Prison Service (UPS) conducts on prison entry medical screening for every individual entering the prison system in major prisons in the country. This is aimed at determining pre-entry health problems especially related to HIV, TB and Malaria among others. This further offers an opportunity for prisoners to test for HIV and other diseases. Early detection and treatment prevents transmission of disease in the already vulnerable prisons population. HIV testing is important among prisoners, pregnant prisoners and staff community members as it the entry point to care and treatment, TB and PMTCT programs.

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? Sub 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 ActivitiesHVOP Uganda Prisons Service 6169 Printing of IEC materials as a BCC strategy for risk reductionHVSI Uganda Prisons Services 2500 Procurement of computers in support of computerizing the health management information systemOHSS Uganda Prisons Services 85558 Capacity building through conducting of six trainings in various disciplines: (i) Peer education for PWD in 13 regions, (ii) 40 health workers in infant and young child feeding including breast feeding, (iii) 25 health workers in comprehensive HIV/AIDS care, (iv) 40 service providers on STD management, (v)34 health workers in comprehensive ART care, (vi) 128 health workers in HIV/TB service delivery leaders among prisoners to engage in community mobilization and (vii) monitoring of activities.

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. Uganda Prisons Service (UPS) will support the provision of care services to 2,358 adults 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.

The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. UPS will be expected to implement approaches to promote an effective CoR model and monitor key indicators along the continuum.

UPS will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance. The program will strengthen positive health dignity and prevention services, strengthen linkages and referrals using linkage facilitators, implement quality improvement for adherence and retention, pain and symptom management.

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% to 100% over the next 12 months. UPS 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, they will need to regularly keep track and report on client waiting lists.

UPS will liaise with PACE and UHMG for provision and distribution of basic care kits and family planning commodities to clients respectively. The National Medical Stores will supply other HIV commodities including cotrimoxazole and lab reagents. UPS will build the capacity of facility staff to accurately report, forecast, quantify and order for these commodities in a timely manner.

In addition, UPS will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support integration of other health and nutritional services.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. UPS will work under the guidance of MoH/ACP and the Quality Assurance Department for trainings, mentorship and supportive supervision.

The Uganda Prison Service (UPS) 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. UPS will contribute to this target by screening 2,332 HIV positive clients in care for TB; and 78 will be started on TB treatment.

UPS will improve Intensified Case Findings (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 including GeneXpert and fluorescent microscopy. UPS will support MDR-TB surveillance through sputum sample transportation to GeneXpert hubs and receipt of results at facilities.

In FY 2013, UPS 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. UPS will increase focus on adherence and completion of TB treatment, including DOTS through the use of proven low cost approaches. A TB infection control focal person will be supported to enforce infection control at facilities using interventions such as: cough hygiene, cough sheds and corners, fast tracking triage by cough monitors and ensuring adequate natural ventilation.

The MOH/ACP and National TB and Leprosy Program (NTLP) will be supported to roll out provision of IPT, in line with the WHO recommendations.

In addition, UPS will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. Wrap around services will be provided in collaboration with other key stakeholders.The program will be aligned to 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. UPS will work under the guidance of MoH AIDS Control Program, NTLP and Quality Assurance Department in trainings, TB/HIV mentorship and support supervision. Additionally, UPS will support all its health facilities to participate in national external quality assurance for TB laboratory diagnosis.

The Uganda Prison Service (UPS) 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. The program will contribute 233 children in care to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services of which 74,555 are children.

UPS 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 including peers and experienced HIV positive child care takers, and implement quality improvement for adherence and retention. Early Infant Diagnosis (EID) services and focal points at all Prison health 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. UPS will implement community mobilization and targeted activities such as Know Your Childs Status campaigns to identify more children in the surrounding communities of the prisons. Focus will be placed on improved CD4 assessment of pre-ART children for ART eligibility to ensure timely initiation on treatment in line with MoH guidance.

UPS 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 positive health dignity and prevention services including, sexual and reproductive health 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, 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. UPS will also support the integration of HIV services in routine pediatric health services, including the National Child Health Days.

UPS will liaise with PACE for provision and distribution of basic care kits to children and the National Medical Stores for other HIV commodities including cotrimoxazole and laboratory reagents. UPS will build the capacity of facility staff to accurately report, forecast, quantify and order these commodities in a timely manner.

MoH 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. UPS 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) to support and strengthen the national M&E systems. UPS will work under the guidance of MoH/ACP and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and support supervision.

Laboratory infrastructure is critical for improved health care services. UPS will support the renovation of existing laboratories to perform the HIV and other related tests identified. For FY 2012 Uganda Prisons Services (UPS) will target population to include prisoners, prison staff and family members. UPS will renovate the laboratory facility at the Murchison Bay hospital in order to improve access to CD4 testing. UPS will ensure that the available hematology and clinical chemistry and TB diagnostics are well maintained. UPS will also support capacity building for existing staff for conducting high quality tests for HIV testing, monitoring patient CD4 counts for ART initiation, monitoring drug tolerance and testing for other HIV comorbidities. Renovations and capacity building will particularly focus on hard to reach prison populations where access to public health facilities is limited. Renovations will include minor refurbishment (painting, roof repairs and window replacements) that will create a conducive working environment in the laboratories with focus to handling high volumes of laboratory tests. Two remotely situated laboratories will be renovated and laboratories situated in prison facilities with limited resources will be furnished with laboratory equipment. 43 laboratory staff will be trained in various areas of laboratory testing.

UPS will continue to work towards rolling out the national EMR - Open MRS and DHIS2 in close collaboration with MoH. UPS will procure computers to be stationed at 8 regional prison units: these computers will be installed with a management information system to aid the electronic tracking, monitoring and use of strategic information. The information system will enable timely and safe transmission of data from all remotely situated prisons across the country to a central processing system at the prison project office. This will also serve the MoH national data health systems requirements. Furthermore UPS will adapt, harmonize and customize tools for data collection and analysis; these tools should be able to meet all the data needs for UPS and other stakeholders.

UPS will use existing funds to wrap around SI Pivot 2 Increased use of data for evidence based planning and decision making at all levels in all program areas.

UPS will conduct a Sero-behavioral survey for prevalence and incidence of HIV and associated behavioral and biomedical correlates among prisoners and staff. Data from the survey will provide up to date information about the burden of disease among prisoners and staff and subsequently inform service provision.In addition UPS will establish a sero-behavioral surveillance system to cover 11 regional prisons across the country. The system will ensure timely access to data and information about the state of the HIV epidemic in the prison establishment, and implement timely interventions.Findings from this survey will feed into MoHs HIV survey portfolio, and, thus inform health programming for this key population group.

Under Pivot 3 Strong/robust basic M&E systems at service delivery points and districts UPS will strengthen the capacity of staff to collect, enter, analyze, interpret and use the data collected at the regional prison health facilities. In achieving this activity all health care providers, information management staff at all levels including custodian and non- custodian staff will be trained in recording, managing, reporting and dispersing data. Also UPS will support SI fellowships and short-term trainings as will be required from time to time, and will conduct appropriate evaluations of the program.facilities. In achieving this activity all health care providers, information management staff at all levels including custodian and non- custodian staff will be trained in recording, managing, reporting and dispersing data. Also UPS will support SI fellowships and short-term trainings as will be required from time to time, and will conduct appropriate evaluations of the program.

The goal of Uganda Prison Services Program is to achieve HIV Testing and Counseling (HTC) for 5,000 prisoners with 2,050 males and 2,950 females by doing Voluntary Counseling and Testing (VCT) on entry of prisoners into prison, outreach testing clinics for prisons without health facilities and Provider Initiated Testing and Counseling (PITC) at the prison health facilities. The program will contribute to the overall HTC goals for PEPFAR by increasing access to and use of essential counseling and testing services for the most-at-risk populations and other key populations determined by existing data on HIV prevalence in Uganda. The program will engage in scaling up VCT in all the prison and PITC in specific prisons with functional health facilities and customized interventions relevant to key populations. This program will contribute to the continuum of response by linking clients to other health services including HIV care and treatment and social support services tailored and customized to prison settings and the prison community with the aim of increasing demand and adherence for positive clients.

Program targets reflect the prioritization of prisons with high HIV/AIDS prevalence and unmet need. Partner and district-level capacity was also key factors in determining the allocation of program resources. Project coverage is 224 prisons situated all over the country including the Luzira complex in Kampala where the only UPS referral hospital is situated. The target populations in these prisons will vary depending on need but particular will focus on largely prisoners, prison staff, family members of the prison staff and the communities surrounding the prison barracks. In so doing special groups will also indirectly targeted for this HTC intervention including: commercial sex workers, drug users and men who have sex with men; these categories are common in the prison settings.

Currently, PEPFAR contributes to more than half of the Ministry of Healths HTC targets. Recognizing the important role of GOU, HTC program activities shall be conducted in partnership with district local governments under stewardship of the MoH, recognizing that the scale-up of activities will require a medium-term commitment by the USG.

The program will work in partnership with the Medical Access Uganda Limited to ensure a steady supply of HIV rapid test kits for HTC services to be delivered efficiently.

Additionally, in order to maximize program success, this program will work towards evidence gathering for the purpose of standardizing service delivery, to ensure consistency with World Health Organizations HTC Quality Assurance/Quality Improvement guidelines.

UPS focuses on the prisoners, prison staff and their families. The majority of this population are aged 18 years and above and both women and men reside within the prison wards and /or the prison barracks. UPS coverage is at national level, at specific prisons situated across the country. The program will provide condoms, prevention messages and prevention counseling to the prisons population.

All prisoners exiting the prisons will be provided with condoms and 140 condom distribution outlets will be established. These outlets are within the 224 prisons in the system.

UPS under this program area, will reach out to prisoners as MARPS and among these are other categories including Female Sex Workers (FSWs) and Men that have Sex with Men (MSM) who are part of the incarcerated populations. In FY 2012/2013 UPS will provide a combination of the other prevention strategies to 35,000 males and 2000 females for a total of 37,000. This will be in 130 prison units located all over the country including former local government prisons the 50 former central government prisons. In the FY 2012/2013 UPS will increase the number of condom distribution outlets from 63 to 150. It is targeting to reach 37,000 MARPS (35,000 males and 2,000 females) with HIV prevention interventions.Provision of prevention messages and implementation of prevention interventions are a critical part of routine prison health activities. UPS will continue to offer all newly admitted prisoners on entry medical screening and particularly HIV prevention messages by health providers or peer educators. Peer education and counseling assistant programs will be initiated at other 70 prisons where they have not been existent.

In FY 2013, Uganda Prisons services (UPS) will facilitate the implementation of PMTCT Option B+ activities in four PMTCT sites.

Key strategic pivots for PMTCT will focus on:

1) Improving access and utilization of eMTCT services in order to reach more HIV infected pregnant women as early as possible during pregnancy. To achieve this UPS will ensure provision of universal HTC services during ANC, labor and deliver, and community mobilization.

2) Decentralizing Treatment and Option B+ through the accreditation of PMTCT sites at one hospital and three prison regional Health center IV levels. Activities will include site assessments for accreditation; identification of training needs; procurement of equipment; printing M&E tools, job aides, and Option B+ guidelines, training of service providers and sample referral system for CD4+ and Early Infant Diagnosis (EID). The transition of Option B+ in UPS sites will be done in accordance with MOH guidance and a total of three sites will be accredited by end of FY 2013.

UPS will support the delivery Option B+ services using a Family Focused model within MNCH settings. In this model family support groups will be formed at all PMTCT sites and will meet monthly to receive adherence counseling and psycho-social support, Infant and Young Child Feeding (IYCF) counseling, EID, family planning (FP) counseling, couples (HIV Testing and Counseling (HTC) supported disclosure and ARV refills. Village health teams will also be utilized to enhance follow-up, referral, birth registration, and adherence support. Through this model, male partners of prison staff and family members will receive condoms; STI screening and management; support for sero-discordant couples; treatment for those who are eligible and linkage to Voluntary Medical Male Circumcision (VCCM). At least 200 partners of pregnant women prison staff and family members will be tested within the MNCH setting.

3) Supporting intensive M&E of activities to inform Option B+ roll out through cohort tracking of mother-baby pairs and electronic data reporting. All sites will actively document services provided to the mother-baby pairs at both facility and community level. Each beneficiary will have a standard appointment schedule that will be aligned to the follow-up plan of each PMTCT site. Mobile phone technology will be used to remind mothers and their spouses on appointments, EID results and ARV adherence. Service providers will conduct home visits to trace client who are lost to follow-up. All sites will submit daily reports on key program elements electronically to support effective monitoring and timely management.

4) Facilitating quarterly joint support supervision and mentorships at all PMTCT/ART sites involving MOH, AIDS Development Partners, districts, USG, and Implementing Partner (IP) staff in accordance with MOH guidance. Site level support will entail cohort reviews, adherence rates, retention rates, data management, availability of supplies, commodities and tools, and knowledge gaps.

5) Integrating voluntary and informed FP services with PMTCT service UPS will ensure FP sessions are integrated within PMTCT trainings, counseling; education, and information during ANC, labor and delivery, and postnatal periods as well as for women in care and treatment; based on respect; womens choices; and fulfillment of their reproductive health rights.

The Uganda Prison Service (UPS) will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. The program will enroll at least 967 new adult clients and support 1,705 adults and children current on ART by APR 2013, contributing to overall national and PEPFAR target of 190,804 new clients and 490,028 individuals current on treatment. This 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 (Prisoners).

UPS will support the MoH roll out of Option B+ for eMTCT through the following activities: training, mentorship and joint PMTCT/ART support supervision. UPS 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. UPS will support integration of reproductive health services including family planning.

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

UPS will liaise with UHMG for provision of family planning commodities for clients and the National Medical Stores for ARVs and other HIV commodities including cotrimoxazole and lab reagents . UPS will build the capacity of facility staff to accurately report, forecast, quantify and order these commodities in a timely manner.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. UPS will work under the guidance of MoH AIDS Control Program and Quality Assurance Department in trainings, ART/PMTCT mentorship and support supervision.

The Uganda Prison Service (UPS) will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. The program will enroll at least 108 new HIV positive children and support 221 children current 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. In FY 2013, UPS will support the national program to scale up pediatric treatment through strengthening the identification, follow up and treatment for all infants through Early Infant Diagnosis (EID) focal persons, peer mothers, SMS messages/phone calls and flagging files with initiate ART immediately stickers for all children eligible for ART. Facilities will be supported to strengthen test and treat for all HIV positive under two years in line with the national treatment guidelines.

UPS will support the early initiation, adherence and retention of adolescents on treatment using expert peers and adolescent support groups. They will be provided with positive helath dignity and prevention 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. UPS will support the integration of HIV services in routine pediatric health services, including the National Child Health Days.

UPS will liaise with PACE and UHMG for provision and distribution of basic care kits and family planning commodities to clients. In additional National Medical Stores will supply ARVs and other HIV commodities including cotrimoxazole and laboratory reagents. The program will build the capacity of facility staff to accurately report, forecast, quantify and order these commodities in a timely manner.

UPS 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.

Other key stakeholders will be collaborated with for provision of required wrap around services.The program will be aligned to the National Strategic Plan for HIV/AID (2011/12-2014/15) to, support and strengthen the national M&E systems. UPS will work under the guidance of MoH/ ACP and the Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework and support supervision.