Research Triangle Institute (RTI Intl) is an international, independent not-for-profit organization dedicated to improving the human condition through multidisciplinary technical assistance, training and research services that meet the highest standards of professional performance. RTI was awarded this project in November 2008 to support the Uganda Peoples Defense Forces to improve access to and utilization of quality HIV-related services by the military and their families. The primary objectives of the project include: Improving knowledge of HIV sero-status among soldiers and their families; Strengthening prevention of mother-to-child transmission (PMTCT) of HIV among military families; Strengthen basic and specialized care and treatment of HIV infected soldiers and dependants; Improve diagnosis and management of TB-HIV co-infection among military families; and Support mitigation of HIV impact for orphans and vulnerable children (OVC) in military families. For the past three years, RTI has provided comprehensive support in various aspects of HIV programming to 10 core and other military health facilities across the country. In FY2012, RTI will additionally support the scale up of safe male circumcision as part of the comprehensive HIV prevention package. RTI support will focus on activities that strengthen systems to further build the institutional capacity for sustainability. RTI will promote quality service delivery by emphasizing capacity building through in-service training and technical support to the different HIV program areas to improve providers knowledge and skills; strengthening commodities supply chain management, and close monitoring of performance of the supported facilities.

In FY2011, RTI expanded its support from 6 to 10 UPDF health facilities from Northern, Eastern, Western and Central Uganda, increasing access to comprehensive HIV care and support services by HIV-positive patients of all age groups in the supported facilities. The support provided include remodeling of ART clinic space, supply of furniture and basic equipment for patient management, supporting baseline CD4 testing collection, transportation of blood samples to the reference laboratory, Septrin supplementation to minimize stock-outs, and instituting quality improvement measures in service delivery. Four ART clinics were remodeled and equipped with furniture for patients and clinicians and all ART clinics for the 10 supported facilities received basic equipment for patient care. By August 31st, 2011, 316 new HIV+ clients had been enrolled at the 10 supported facilities and a total of 4,214 patients were enrolled on HAART.In FY2012, DOD-UPDF will continue to provide support to all ART military facilities across the country focusing on institutional capacity building and systems strengthening in order to consolidate achievements made in FY2011. DOD-UPDF with support from RTI will provide care services to 29,268 HIV positive uniformed personnel, their families and individuals in the catchment areas. Remarkable improvement has been made in the past year in increasing access to both comprehensive HIV care and support services, and in the quality of patient management. However, routine performance assessments done during technical support visits showed gaps in linkages between diagnosis and chronic care and patient retention into care and adherence to treatment. RTI will implement approaches to promote an effective continuum of response model and monitor key indicators along the continuum. In view of this, RTI support in FY2012will focus on: i)strengthening linkages between diagnosis and chronic care through improved patient referral from HCT, PMTCT, TB, OVC, VMMC and other Health service delivery points within and outside the facilities using linkage facilitators. ii)strengthening adherence monitoring and counseling by the health care workers in the ART clinics of all the 10 supported facilities health care providers will be re-oriented on adherence monitoring and counseling, and routine supportive supervision. The project will also support the establishment and running of two satellites ART clinics for troops in hard to reach areas that are currently receiving their treatment from Mubende and Moroto. iii) Scale up the number of clinician and nurses teams who take short courses in HIV chronic care, with special focus on pediatric HIV care 60 health workers will be trained to bridge the knowledge gap resulting from transfer and recruitment of new health workers. To further bridge the existing human resource gaps in the facilities, we will continue to support the use of a minimum of 4 volunteer health workers and/or PHAs per target facility to provide counseling, psychosocial support and helping patients to develop sexual behavior, care and treatment plans in order to prevent HIV transmission and improve adherence.Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation in line with MoH guidance. RTI will support sample referral and will monitor and report clients access to CD4 in quarterly reports. In addition, RTI will regularly keep track and report on client waiting lists.

One of RTIs project objectives is to support the mitigation of HIV impact for orphans and vulnerable children (OVC) in military families. In FY2011, OVC support focused on building the Institutional (UPDF) capacity to provide care and support to OVCs living within the military bases. Activities undertaken by the RTI team include the establishment of OVC implementation committees and focal persons in two facilities (Kakiri and Mubende), and training 27 committee members on OVC programming, care and support. Through OVC implementation committees, the project identified and enrolled 264 OVC households for support. All enrolled households received support in at least 3 core program areas (health, nutrition and food security, education, and social economic security) as well as receiving psychosocial support for both caregivers and enrolled children. In FY2011, RTI supported the training of OVC caregivers from all 264 supported households on parenting, caring and supporting OVCs. Caregivers were also trained on vegetable and cereal growing to improve on their crop yield.In FY2012, RTI will consolidate achievements made in FY2011 in the two currently supported military facilities, while scaling up to two more facilities in Northern and Eastern Uganda. The two new facilities will be selected based on the number of OVCs living within the bases, and on their level of vulnerability. The 264 OVC households supported in FY2011 will be maintained with an additional 236 households enrolled from the two new facilities, to make a total of 500 OVC households receiving project support with 1200 OVCs reached. Activities will focus on further building the capacity of OVC caregivers to effectively provide care and support for OVCs, as well as building the skills of the UPDF staff/facility OVC implementation committees to increase demand for services and improve linkages with the health care system.. For example, to further build OVC caregivers capacity to support OVCs, RTI will conduct a 3 day training for the 236 newly identified caregivers. Training will focus on building caregivers knowledge and skills on; child development and needs, good parenting and guardianship, how to communicate with children, Child Rights and Abuse, and child support systems. Lessons will focus on increasing caregivers understanding of their roles in supporting the different categories of vulnerable children and the role of the government, local leaders and at of implementing partners in providing additional support. 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. OVC Implementation committee will take the lead to make sure that all HIV positive children, who are receiving support and not on treatment, will be linked to a facility OVC focal person to be enrolled for treatment services. Similarly, children identified at facility to be HIV positive and not receiving community social services will be liked to OVC implementation committee by a facility OVC focal person. Child protection issues shall be emphasized and RTI will take the advantage of existing structures responsible for children issues. In every barracks there is a Family and Well fare committee that takes care of all child abuse cases.

In FY 2011, RTI supported TB/HIV co-infection service in 10 military health facilities. The support activities mainly aimed at promoting early TB detection and treatment among HIV infected patients. By August 31, 2011, close to 4214 HIV- positive patients had been screened for TB and 228 new TB patients started on TB treatment. To further build capacity of health workers to effectively manage TB/HIV co-infected patients, RTI targeted and trained 45 lower cadre health care workers (clinical officers and nurses) on TB/HIV collaborative activities.DOD-UPDF will focus on supporting the GOU to scale up TB/HIV integration; and specifically aim to achieve TB screening of 90% of HIV positive clients in care. This will be done in the districts of Gulu, Kampala, Mubende, Pader, Nakasongola, Luwero, Wakiso, Mubende, Tororo and Moroto. 26,341 HIV positive clients will be targeted for TB screening and a target 878 individuals will be started on TB treatment.During FY 2012, RTI will continue to support efforts that provide cross-referral and integrate diagnosis, treatment and support services for TB and HIV in 10 target military facilities across the country. HIV-positive individuals will be actively screened at initial diagnosis and during follow up at chronic care clinics and the TB positives treated. The program will also promote provision of HIV counseling and testing to all patients in the TB clinics. RTI will further build the capacity of health care workers from the 10 military facilities to better understand policies and guidelines for integrating TB/HIV interventions - 100 health workers will be reached with in-service training on TB/HIV co-infection. This will lead to better management of TB/HIV co-infected patients, to maximize TB case detection, increase treatment completion rates including DOTS and ART literacy. A focal person will be supported to enforce infection control at facilities using interventions such as: cough hygiene, cough sheds and corners ensuring adequate natural ventilation, etc. In addition, the project will continue to support the implementation of the national Intensified Case Finding strategy within the target military health facilities. TB Infection control measures in HIV care settings will be enhanced through literacy campaigns for patients and health workers, triage of symptomatic patients and enhanced TB case-finding. RTI will collaborate with MOH/NTLP to ensure a constant supply of TB drugs, and ARVs to TB/HIV co-infected patients. Furthermore, the project will collaborate with NTLP to roll out the revised national TB/HIV treatment guidelines, infection control and MDR-TB guidelines to all support UPDF facilities.

The goal of the pediatric HIV care and support program is to extend and optimize quality life for HIV infected children of military families and surrounding communities, through the continuum of illness by provision of clinical, psychological, spiritual, social and prevention services. The services are provided using mainly the facility based approach, in 12 ART accredited centers. RTI continued to build the capacity of UPDF health workers in pediatric care management through trainings. A total of 20 health workers were trained in specialized pediatric HIV care and treatment from 10 clinics. This enhanced health workers skills and knowledge in providing pediatric care. RTI staff will conduct follow up visits on trained health workers to assess the progress made on pediatric HIV care integration and providing on site mentorship and technical support. RTI will continue to provide supplemental pediatric septrin formulation buffer stock in all supported clinics.In FY2012, 2,671 HIV positive children will be targeted for enrolment into the care and support program. RTI will support comprehensive child friendly care and support services to all facilities among the Ministry of Health accredited ART facilities 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. 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.

RTI 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.The program will support referral of blood samples for HIV positive children for CD4 testing and timely return of results. Short courses for clinical officers and nurses in pediatric care and treatment will be conducted and be given special emphasis. RTI will work in collaboration with the MOH-ACP to distribute the pediatric HIV care and treatment guidelines and job aids to all health workers involved in pediatric HIV care and treatment.All new health care workers in the supported health facilities and in the two new facilities will be trained to provide facility-based palliative care and /or referral for further assessment and specialized care for HIV+ children. Refresher training and technical support supervision will be provided as needed to ensure quality delivery of Palliative Care services for children. In order to minimize stock-outs, RTI will support health unit staff in forecasting and requisitioning for the right amounts of drugs and other basic care supplies.

In FY 2011, NAMERU was involved in the development of human capacity in the HIV clinic data collection, management and reporting. A total of 28 data managers were trained, and all required data capturing and reporting tools were provided to all supported health facilities. They aimed at setting up a functional paperbased HIMS that can accurately and timely report relevant data according to national and PEPFAR reporting needs. Computer based data management with internet reporting was introduced in all supported health facilities. A data base has been introduced and they are testing out an electronic data based system.In FY 2012, NAMERU will aim at transforming all the paper based medical records into an electronic form. Data collection tools will be supplied to all UPDF ART health facilities. A core support team will be trained in electronic data base management so that these can offer on-job training of the UPDF data clerks and health workers. This aims at launching a functional integrated internet based HIMS where data from all clinic sites can be accessed by the data managers at the center. UPDF M&E staff, Division and Unit data managers, will receive training and mentoring on data management. NAMERU will also carry out data validation and behavioral surveillance in the UPDF. NAMERU will contributions towards strengthening national systems for Treatment monitoring, evaluation, and health information. NAMERU will enhance monitoring and reporting through the MOH HMIS tools and periodic quality assessments (DQA). Data use will be strengthened through supporting monitoring and evaluation focused in-service training for health workers to foster program improvement.

In FY2011, UPDF provided VMMC services at 4 static sites namely- Bombo, Gulu, Mbarara, and Katabi, circumcising about 700 men. Male circumcisions is highly acceptable among uniformed men however service delivery is limited by human resources, commodities availability, and administrative and other structural issues that influence uptake of VMMC.In FY2012, RTI will provide technical support to the UPDF team to scale up VMMCservices. A total of 21,011 men will be circumcised by DOD-UPDF as a contribution towards the target of 750,000 men. UPDF VMMC implementation strategy will been redesigned with the aim to: 1) Increase uptake of VMMC up to 80% of all eligible males in the UPDF, by utilizing static and mobile VMMC service delivery teams; 2) Provide VMMC as part of comprehensive HIV prevention package that includesrisk reduction, increased condom use, reduction in the number of sexual partners, early identification and treatment of sexually transmitted infections, and prevention for positives and; 3) Provide linkages to care and treatment for PLHWAs identified during the VMMC campaigns.The program will primarily target men aged 15 49 years, to include UPDF staff, their dependents and civilians. VMMCwill be provided for only eligible males who voluntary consent for the surgical procedure. VMMC service delivery will be expanded to two more static facilities and three mobile teams that will cover military personnel in underserved hard to reach areas across the country.In order to increase demand, RTI will work hand-in-hand with the UPDF Medical Directorate, MOH and DOD/PEPFAR VMMC members to sensitize and solicit support from UPDF leadership to take a lead in the communication and mobilization of the uniformed men for VMMC services. There will be a high level of planning and coordination for VMMC activities so that uniformed personnel are available at the time when the services are offered, and are given time-off after surgery, including some days of light duty, 1-2 weeks after surgery. The VMMC site coordinators, UPDF health care providers and peer educators will reach the target population with VMMC messages during ongoing routine HIV prevention education activities, and through VMMCspecific mobilization activities.In order to ensure quality, VMMC clinical protocols and guidelines will be provided to ensure that teams offer services based on the recommended national and international standards. Standard surgical approach that is simple, safe and effective, requiring minimal specialized skills will be adapted to reduce the probability of complications and to allow appropriate task-shifting to health-care cadres with lower qualifications and; the team will receive support supervision once every three months during which the providers performance will be assessed based on a standard quality checklist and onsite feedback and mentorship will providedExternal quality assurance (EQA) will be implemented and monitoring and reporting of all activities will be done. RTI with NAMERU will enhance monitoring and reporting through the MOH HMIS tools and periodic quality assessments (DQA). Data use will be strengthened through supporting monitoring and evaluation focused in-service training for health workers to foster program improvement.

In FY 2011, NAMERU implemented an injection safety program in all the 14 UPDF supported health facilities and will seek to build on this for sustainability and consolidation.The program has so far trained a total of 740 UPDF health workers and medical waste handlers in 14 UPDF health facilities. NAMERU has ensured a consistent supply of injection safety materials such as singleuse syringes, personal protective equipment, safety boxes, medical waste bins and waste paper bags. They have reprinted and distributed National Policy and Guidelines to all health workers and facilities. Also provided are Information, Education and Communication materials to reinforce behavior change.During FY 2012, NAMERU will continue to support injection safety program in the following area;Trainings- Refresher trainings will be arranged for all the health workers and medical waste handlers at the 14 UPDF health facilities. Trainings will focus on safe blood drawing procedures, proper handling of medical waste and the general principles of minimizing medical transmission of HIV/AIDS in particular and blood-borne diseases in general.Promotion for behavior change will be emphasized and all necessary IEC materials will be printed and displayed in all supported facilities. In addition, Ministry of Health Guidelines and standards for injection safety and proper medical waste management will be provided.Supply of injection safety materials will be maintained in all the supported health facilities. In addition, every supported health facility shall offer Post Exposure Prophylaxis (PEP) services and a log of all occupational and other exposure occurrences kept. Every supported health facility will have a designated PEP focal person who will offer a comprehensive PEP package including counseling, testing and drugs.

During FY2011, RTI supported behavior change activities in 10 target military facilities in the different parts of the country. The activities targeted in-school male and female youth between the age of 10 -14 years mainly pupils in the upper primary school; in-school and out-of school youth between the ages of 15- 24 years, and; Adults 25+ years mainly uniformed personnel and their partners. Behavioral change message were disseminated through small dialogue meetings of 20-25 people. A total of 7,798 individuals were reached with ABC messages and 5,781 with A only messages during FY2011.In FY 2012, RTI will continue to support sexual prevention activities for behavior change in all the 10 target military facilities, other military facilities, and the Mobile VMMCMC unit. The project will target adolescents in and out of school in the age groups 10 -14 years and 15- 24 years, and adults 25+ years mainly the uniformed personnel and their partners. School going youths from upper primary level through secondary schools will be reached at school by health care providers from the military health facilities in collaboration with school teachers who received training in abstinence and being faithful (AB) information dissemination approaches. Out of school youths and adults will be reached through small group community dialogue meetings and health education sessions organized in collaboration unit commanders and welfare officers. Similar to those organized in schools, participation in each meeting will range between 20-25members. Each of the 10 health facilities will conduct at least 1 outreach per week, each one of the categories will be targeted every month. The facilitators involved in the dissemination of information will receive orientation to update their knowledge on AB information dissemination and will receive a package of materials to use in the dialogue meetings in order to standardize the information to be disseminated. Project staff will conduct regular monitoring activities including sit-in sessions, exit interviews to participants and program review of field activity reports to ensure the program is implemented effectively. This activity proposes to reach 10,000 individuals with AB messages while Abstinence only messages will reach 3300 individuals.

During FY2011, RTI supported behavior change activities in 10 target military facilities in the different parts of the country. The activities targeted in-school male and female youth between the age of 10 -14 years mainly pupils in the upper primary school; in-school and out-of school youth between the ages of 15- 24 years, and; Adults 25+ years mainly uniformed personnel and their partners. Behavioral change message were disseminated through small dialogue meetings of 20-25 people. A total of 7,798 individuals were reached with ABC messages and 5,781 with A only messages during FY2011.In FY 2012, RTI will continue to support sexual prevention activities for behavior change in all the 10 target military facilities, other military facilities, and the Mobile VMMCMC unit. The project will target adolescents in and out of school in the age groups 10 -14 years and 15- 24 years, and adults 25+ years mainly the uniformed personnel and their partners. School going youths from upper primary level through secondary schools will be reached at school by health care providers from the military health facilities in collaboration with school teachers who received training in abstinence and being faithful (AB) information dissemination approaches. Out of school youths and adults will be reached through small group community dialogue meetings and health education sessions organized in collaboration unit commanders and welfare officers. Similar to those organized in schools, participation in each meeting will range between 20-25members. Each of the 10 health facilities will conduct at least 1 outreach per week, each one of the categories will be targeted every month. The facilitators involved in the dissemination of information will receive orientation to update their knowledge on AB information dissemination and will receive a package of materials to use in the dialogue meetings in order to standardize the information to be disseminated. Project staff will conduct regular monitoring activities including sit-in sessions, exit interviews to participants and program review of field activity reports to ensure the program is implemented effectively. This activity proposes to reach 10,000 individuals with AB messages while Abstinence only messages will reach 3300 individuals.

In FY 2011, UPDF piloted Commander Peer led training in the second division that was successfully implemented. In this strategy, commanders at each level were selected and trained as peer educators for their respective peers. A total of 250 Commander Peer educators were trained and passed out. These peer educators unlike the previous peer educators will be able to reach their respective peers with ease. In addition, Senior Commanders from UPDF medical services and HIV Directorate carried out a sensitization campaign on Alcohol and drug abuse within all 5 divisions of UPDF.During FY 2012, other sexual prevention program will focus on increasing access to condoms by the military community. This will be achieved through placing condoms in all health facilities in places with easy accessibility. In addition, peer educators and counselors will be given condoms for distribution whenever they are conducting health education talks. Condoms will primarily be obtained from the national Ministry of Health procurement system.DOD will continue to support current activities that include health education/film shows/drama show outreaches integrated with HIV Counseling and Testing outreaches, health talks at military parades and training institutions to further build the capacity of UPDF personnel for sustainability purposes. Peer educators will be engaged in quarterly review meetings to keep track of their performance and where possible refresher trainings be organized to equip them with new information and skills in HIV prevention. UPDF HIV Directorate will continue to take advantage of every social event like football shows, army week, world AIDS day to show case for HIV prevention, like supporting a popular commander to address the participants, facilitating PHAs to give testimonies and others.

During FY2011, RTI supported PMTCT activities in ten military hospitals (Kakiri, Katabi, Mubende, Rubongi, Nakasongola, Mbarara, Bombo, Gulu, Acholi Pii and Moroto) across the country targeting a minimum of 80% of pregnant women and 25% of partners of pregnant women attending ANC in these facilities. RTI supported routine counseling and testing of pregnant mothers and their spouses in ANC; linkage to care and support services; assessment of HIV-positive mothers for ART; enrollment into chronic care; provision of HAART and prophylactic ARVs to the mothers and babies; and training health workers on PMTCT service delivery to enable them to effectively provide PMTCT services. In FY2011, a total of 1,254women were counseled tested and received results, and 254 mothers and babies received ARV prophylaxis. In addition, 60 health workers were trained on PMTCT-EID strengthening strategy.In FY2012, RTI will continue providing support to the 10 health facilities to consolidate achievements made and to further strengthen systems for implementation of the PMTCT-EID cascade. The project will promote the integration of PMTCT activities within the routine maternal and child health services at the target facilities. RTI support will also focus on activities that empower facilities to provide a continuum of PMTCT services, strengthening linkages between PMTCT and other HIV program areas within and outside the supported facilities. The project will support facilities to provide routine counseling and testing of pregnant women and partners; assess HIV-positive women for ART eligibility; enroll patients into care and support; provide ARVs to HIV-positive pregnant women and prophylactic ARVs to their babies; perform HIV testing for exposed infants; promote good infant feeding practices; and provide screening for sexually transmitted diseases.RTI will also continue to support activities that enhance links between community and facility services so that they will complement and reinforce each other for maximum impact on PMTCT; on the health of mothers; and on the preventive, mobilizing effect of the program on the community at large. The project will promote the use of pregnant women as index contacts to support the involvement of partners in the PMTCT program by promoting HIV testing for family members; couples counseling; disclosure of sero-status; and support for discordant couples. RTI will continue to build the capacity of health workers to provide quality PMTCT services through technical support and on site mentorship, continuing medical education, and short course in-service trainings. Through this effort 3,829 mothers will receive HTC and 91 pregnant women with known HIV status reached. The same number will be assessed for ART eligibility while 261 women will receive antiretroviral drugs for MTCT risk reduction. 276 babies born to these mothers will receive EID and all positive babies will be started on ART.Although the budget is zero, these activities will be carried out using the $150,000 acceleration PMTCT funding that was received.

The goal of the adult treatment program area is to extend and optimize quality life for HIV infected clients and their families, through management of common illnesses, improving clinical infrastructure and provision of monitoring laboratory tests.During FY2011, RTI a DoD-UPDF implementing partner focused on promotion of quality management of patients in all supported health facilities with the ART clinics. In addition 1 ART satellite clinic was established in Ntungamo army detach in Mubende for easy accessibility of services by the clients. A team of health workers from Mubende army hospital was supported with logistics to conduct a monthly satellite clinic at Ntungamo. In Mubende, RTI emphasized on improving knowledge of health workers on pediatric HIV Care, mentorship to health workers in ART clinics, HIV patient CD4 monitoring and supplementation of prophylaxis drugs. RTI supported Moroto health facility to organize the clinic space previously remodeled, and also supported ART clinic staff to come up with modalities to strengthen linkages between PMTCT mothers and babies and the ART clinic.Following the supply and installation of Point Care CD4 machines in Acholi Pii, Mbarara, Moroto and Nakasongola, access to CD4 testing has significantly improved. Other sites like Kakiri, Mubende, Katabi, and Rubongi were supported to refer their samples to reference laboratory for CD4 testing.In FY2012 RTI will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. DoD-UPDF with support from RTI will enroll at least 5,131 new clients both 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.

RTI will support the MoH roll out of Option B+ for eMTCT through the following activities: training, mentorship and joint PMTCT/ART support supervision.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. RTI will expand and give support to 5 ART satellite clinics in the hard to reach and underserved areas of Moroto and Mubende.

RTI 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 appointment registersSpecial 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 using Point Care CD4 machines. RTI 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.

The goal of the pediatric HIV care and support program is to extend and optimize quality life for HIV infected children of military families and surrounding communities, through the continuum of illness by provision of clinical, psychological, spiritual, social and prevention services. The services are provided using mainly the facility based approach, in 12 ART accredited centers. RTI continued to build the capacity of UPDF health workers in pediatric care management through trainings. A total of 20 health workers were trained in specialized pediatric HIV care and treatment from 10 clinics. This enhanced health workers skills and knowledge in providing pediatric care. RTI staff conducted follow-ups on trained health workers to assess the progress made on pediatric HIV care integration and providing on site mentorship and technical support. RTI will continue to provide supplemental pediatric Septrin formulation buffer stock in all supported clinics.In FY 2012 as a contribution to the national targets, DOD-UPDF will enroll at least 2,671 new HIV positive children and support 467 children on ART by APR 2013.RTI will continue its support to provision of comprehensive pediatric HIV care services to all facilities among the Ministry of Health accredited ART centers. RTI will support 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 year olds in line with the national treatment guidelines. 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.The program will support referral of blood samples for HIV positive children for CD4 testing and timely return of results. Short courses for clinical officers and nurses in pediatric care and treatment will be conducted with special emphasis on pediatric care and treatment. RTI will work in collaboration with the MOH-ACP to distribute the pediatric HIV care and treatment guidelines and job aids to all health workers involved in pediatric HIV care and treatment.All new health care workers in the supported health facilities and in the two new facilities will be trained to provide facility-based palliative care and /or referral for further assessment and specialized care for HIV positive children. Refresher training and technical support supervision will be provided as needed to ensure quality delivery of Palliative Care services for children. In order to minimize stock-outs, RTI will support health unit staff in forecasting and requisition for the right amounts of drugs and other basic care supplies. RTI 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.