The Expanded Kibaale-Kiboga Project (IDI-EKKP) implemented by the Infectious Diseases Institute aims to build capacity for HIV/AIDS service delivery in the generally underserved and located in far and hard-to-reach communities in Kiboga, Kibaale, Kyankwanzi, Hoima, Masindi Bulisa and more recently Kiryandongo District. The main purpose of the project is to strengthen HIV/AIDS service delivery in government health facilities. Technical areas of focus include HIV Counseling and Testing; Care and Treatment including TB/HIV co-infection management; Prevention of Mother To Child Transmission; Early Infant Diagnosis; and Pediatric Care. To date, HIV prevention, care and treatment services have been scaled up to 26 health facilities, across six districts.IDI-EKKP implements a health systems strengthening approach for sustainability emphasizing strengthening human resource technical capacity to deliver quality HIV/AIDS services; improving logistics management systems to reduce stock outs; strengthening management of health information to improve evidence based planning and decision making; improving district leadership and management capacity to ensure a sustainable and effectively coordinated HIV/AIDS response; strengthening community structures to create demand, increase awareness and support for HIV/AIDS service delivery; and building the capacity of district laboratories to improve clinical investigative capacity.During FY 2013, IDI-EKKP will increase from 26 to 89 sites including accreditation of at least 72 Health Center IIIs in line with national guidelines and PMTCT scale up plan.Monitoring and Evaluation will be strengthened to support reporting and data use at source.

PEPFAR will focus on supporting the Government of Uganda (GOU) to further expand access to HIV care and support aimed at achieving universal access of 80% in care by 2015. The Expanded Kibaale-Kiboga Project (IDI- EKKP) implemented by the Infectious Disease Institute in Kibaale, Kiboga, Kyankwanzi, Hoima, Buliisa, Masindi and Kiryandongo will support the provision of care services to 36,644 clients as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations such as truck drivers, fishermen, commercial sex workers and men who have sex with men. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. IDI-EKKP will implement approaches that promote an effective CoR model and monitor key indicators along the continuum.

IDI-KKP will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthening positive health dignity and prevention (PHDP), strengthening linkages and referrals using linkage facilitators, implementing quality improvement for adherence and retention, pain and symptom management, and providing support to targeted community outreaches in high prevalence hard to reach and underserved areas.

Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation in line with MoH guidance. This has been a major bottleneck to treatment scale up nationally. Working with the Central Public Health Laboratory and other stakeholders, the project will improve CD4 coverage from the current 60% to 100% over the next 12 months. IDI-KKP 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 keep track and regularly report on client waiting lists.

IDI-KKP will liaise with PACE and UHMG for provision and distribution of basic care kits and with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for other HIV commodities (cotrimoxazole, lab reagents). IDI-KKP will build the capacity of facility staff for accurate reporting, forecasting, quantifying and ordering commodities in a timely manner

IDI-EKKP will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda to support integration with other health and nutritional services. IDI-EKKP will also collaborate with other key stakeholders at all levels provide required wrap around services including family planning.

The program will be aligned to the National Strategic Plan for HIV/AIDS (2011/12-2014/15), support and strengthen the national M&E systems, and work within district health plans. IDI-KKP will work under the guidance of MoH/ACP and the Quality Assurance Department for trainings, mentorship and supportive supervision. Funding has been provided to support the recruitment of 92 additional staff in the districts to meet the achievement of the targets. This will be done working with the Health Systems Strengthening technical working group.

IDI-EKKP will focus on supporting the GOU to scale up TB/HIV integration; specifically the PEPFAR goal to achieve TB screening of 90% (731,690) of HIV positive clients in care. In addition, the program will 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. IDI-EKKP will contribute to this target by screening 32,980 HIV positive clients for TB and start 1,099 individuals on TB treatment. IDI-EKKP works in seven districts: Kibale, Kiboga, Kyankwanzi, Hoima, Bulisa, Masindi and Kiryandongo.

IDI-EKKP will improve Intensified Case Finding (ICF) and the use of the national ICF tool, as well as, improve diagnosis of pulmonary TB among HIV positive smear negative clients, extra pulmonary TB and pediatric TB through the implementation of new innovative technologies such as GeneXpert and fluorescent microscopy. IDI-EKKP will support MDR-TB surveillance through sputum sample transportation to GeneXpert hubs and receipt of results at facilities.

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

IDI-EKKP will support the MOH/ACP and National TB Leprosy Program (NTLP) to roll out provision of IPT in line with the WHO recommendations.

IDI-EKKP will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda to support integration with other health, and nutritional services. IDI-EKKP will collaborate with other key stakeholders at all levels for provision of required wrap around services.

The program is aligned to the NSP (2011/12-2014/15) and will work under the guidance of MoH/ACP, NTLP and the Quality Assurance Department for trainings, TB/HIV mentorship and support supervision, will support and strengthen the national M&E systems and work within district health plans. Additionally, IDI-EKKP will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

PEPFAR will focus on supporting the Government of Uganda (GOU) to further expand access to HIV care and support aimed at achieving universal access by 2015. The Expanded Kibaale-Kiboga Project (IDI- EKKP) implemented by the Infectious Disease Institute in Kibale, Kiboga, Kyankwanzi, Hoima, Bulisa, Masindi and Kiryandongo will support the provision of care services to 36,644 clients (3,298 of children < 15 years) as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services.

IDI-EKKP will provide comprehensive child friendly care and support services in line with national and PEPFAR guidelines, 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. Early infant diagnosis 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. Emphasis will be on scaling up low cost approaches such as use of caretaker support group to support retention in care. IDI-EKKP will implement community mobilization and targeted activities such as Know Your Childs Status campaigns to identify more children. Focus will be placed on increasing access to CD4 assessment among pre-ART children for ART initiation in line with MoH guidance.

IDI-EKKP 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 incorporating lessons learned from the planned national adolescent service assessment.

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

IDI-EKKP will liaise with PACE and UHMG for provision and distribution of basic care kits and with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for other HIV commodities (cotrimoxazole, lab reagents).IDI-EKKP will build the capacity of facility staff for accurate reporting, forecasting, quantifying and ordering commodities in a timely manner.

IDI-EKKP will work with USG partners such as SCORE, SUNRISE PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda to support integration with other health and nutritional services. IDI-EKKP will also collaborate with other key stakeholders at all levels provide required wrap around services.

The program will be aligned to the National Strategic Plan for HIV/AID (2011/12-2014/15), support and strengthen the national M&E systems and work within district health plans. IDI-EKKP will work under the guidance of MoH/ACP and the Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and supportive supervision.

During FY 2013, changes will be made in PEPFAR support for laboratory program in Uganda in line with the identified pivots. The pivots will focus on a change from facility based to lab network strengthening. Building on success of Early infant diagnosis hubs there will be an increase in the number of hubs from 19 to 72 thus increasing the geographical coverage and access for specimen transportation, testing and result transmission. This effort is aimed at the ART targeted population receiving CD4 tests increasing coverage from 60% to 100% improving the quality of laboratory services, reducing stock outs of reagents, laboratory supplies and commodities, reducing equipment downtime and improving data collection, result transmission, analysis and utilization. To achieve this, technical staff will need to be hired and retained and where possible task shift non-technical activities to appropriately train lay health workers.

Implementation of the WHO Strengthening Laboratory Management Towards Accreditation (SLMTA) will be the mainstay for quality improvement in addition to other quality assurance activities.

The hubs are strategically located health facilities identified by the MoH to serve as coordination centers for specimen referral, testing and result transmission for a catchment area of 30 to 40km radius serving 20 to 50 facilities.

In FY 2012, IDI-KKP will establish six specimen transportation, testing and result transmission hubs in Western Uganda which include Kiryandongo, Masindi, Kagadi and Kiboga Hospitals; Buliisa and Kakindo Health Center (HC) IVs. IDI-EKKP will renovate laboratories for Kiryandongo Hospital and Kakindo HC IV to standardize the infrastructure necessary for CD4 testing equipment. All of the six hubs will receive support to build capacity in CD4 testing. Together with the respective districts, IDI-EKKP will support in the recruitment of 10 laboratory technologists (three each for Kiryandongo and Kagadi hospitals and two each for Kiboga and Masindi hospitals) and six laboratory Technicians (two each for Kiryandongo hospital and Buliisa HC IV and one each for Kiboga Hospital and Kakindo HC IV) to fill in the HRH laboratory gap in the hubs.

Revised COP 12:

Project Purpose: To contribute to the goal of Uganda National HIV/AIDS Strategic Plan of reducing the incidence of HIV by 40% by the year 2012 through use of new proven effective prevention technologies and approaches by implementing Voluntary Medical Male Circumcision (VMMC) activities in the seven districts of central and mid-western Uganda.

In March 2010, the Ministry of Health (MoH) launched the VMMC Policy to guide the integration of VMMC services in Ugandas national health system to reduce the number of new HIV infections, following a recommendation of the WHO that male circumcision be considered as part of a comprehensive HIV prevention package. In Uganda, VMMC will target adolescents and adult males as part of a comprehensive HIV prevention package.

Projections based on computer modeling conducted in Uganda estimate that scaling up the program would result in averting 428,000 adult HIV infections over the time period from 2009 to 2025, and in cumulative net savings of almost US$2 billion over the same time period. To achieve this impact approximately 4,200,000 circumcisions need to be performed by 2014/2015. All PEPFAR funded partners are in the process of accelerating the scale up of circumcision services through various approaches to contribute to the national VMMC target of one million procedures in 2012/2013.

IDI-EKKP will facilitate delivery of VMMC in Kiboga, Kibaale Kyankwanzi, Hoima, Masindi, Bulisa and Kiryandongo districts using multiple delivery approaches including stand-alone sites with dedicated VMMC teams, integrated services within existing health facilities and seasonal outreach activities, and mobile camps to provide 38,032 circumcisions to eligible males. IDI-EKKP will use the Model for Optimizing the Volume for Efficiency (MOVE) as a menu to optimize the efficiencies and increase the volume safely, while paying attention to regular internal and external quality assurance and quality assessments.

IDI-EKKP will employ both media campaigns and person to person message packaging to target men and female partners to increase testing uptake. In particular, community mobilizers will be used targeting localities with high numbers of men like markets, taxi parks, boda boda stages, among others. To support the delivery and scale up of VMMC, IDI-EKKP will train health workers towards VMMC certification using the IDI/IHK public-private partnership.

Data collection using the national HCT tools will be strengthened to support reporting to the VMMC National Operational Center as required by MoH.

Project Purpose: To strengthen HIV/AIDS service delivery in government health facilities in the seven districts of Kiboga, Kibaale Kyankwanzi, Hoima, Masindi, Bulisa and Kiryandongo which are generally underserved and located in far and hard-to-reach communities. Technical areas of focus included, HIV Testing and Counseling (HTC), Care and treatment including TB/HIV co-infection management and Prevention of Mother to Child HIV Infection (PMTCT).

In FY 2012, the project will target 109,300 individuals in the above mentioned six districts and will contribute to the overall HTC goals for PEPFAR by increasing access to and use of essential testing and counseling services to pregnant and breast feeding mothers in ANC settings, at labor, delivery and post-partum. Male partners, families and the general population will be targeted based on existing HIV prevalence data and unmet need.

IDI-EKKP will scale up Provider-Initiated Testing and Counseling (PITC) at all implementing sites and will use innovative outreach approaches in the community including special services to target Key populations (fisher folks and commercial sex workers, and youths in schools). A continuum of response will be ensured by actively linking clients by linkage facilitators to other HIV services. A client tracking system will be established and thereby increasing HIV services demand and retention in care.

Routine quality data collection using the national HCT tools will be further strengthened and analyzed to generate periodic progress reports to be shared with stake holders: local government, partners and MoH.

Data collection using the national HCT tools will be further strengthened. Each service provider will receive a Routine HIV Counseling and Testing (RCT) cue card and each facility a copy of the Standard Operating Procedures (SOPs), HCT policy and implementation guideline.

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.

In FY 2013 IDI-EKKP will provide HIV counseling and testing to 70,000 pregnant women in 89 facilities, identifying 3,500 HIV positive pregnant women. Of these 1,500 will be initiated on HAART for life and 1,800 provided with ARV prophylaxis. In addition, 3,500 exposed babies will receive ARV prophylaxis and DNA/PCR test.

IDI-EKKP will focus on five key strategic PMTCT pivots including improving access and utilization of eMTCT services in order to reach more HIV infected pregnant women as early as possible: decentralizing treatment and Option B+ through the accreditation of all PMTCT sites at hospital, and Health Center (HC) IV and III levels, supporting intensive M&E of activities to inform Option B+ roll out through cohort tracking of mother-baby pairs and electronic data reporting, facilitating quarterly joint support supervision and mentorships at all PMTCT/ART sites involving all stake holders in accordance with MoH guidance, and integrating voluntary and informed family planning services with PMTCT services.

Activities will include mobilizing communities for uptake of services; providing universal HIV Testing and Counseling (HTC) services during ANC, labor and delivery; supporting site assessments for accreditation; training service providers; printing M&E tools, job aides, and Option B+ guidelines, and strengthening sample referral system for CD4+ and Early Infant Diagnosis (EID). The transition of Option B+ in IDI-EKKP sites will be done in accordance with MoH guidance and a total of 89 sites will be accredited by end of FY 2013.

IDI-EKKP 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 counseling, EID, family planning counseling, couple testing and supported disclosure, as well as, ARV refills. Family planning sessions will be integrated in all PMTCT services including trainings and will be based on respect, womens choices, and fulfillment of reproductive health rights. Male partners 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 (VMMC). At least 35,000 partners of pregnant women will be tested within the MNCH setting. Village health teams will also be utilized to enhance follow-up, referral, birth registration, and adherence support.

All sites will actively document services provided to the mother-baby pairs at both facility and community level using a standard appointment schedule aligned to the site PMTCT follow-up plan of each for each beneficiary. 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. Site level support will entail reviews of cohorts, adherence rates, retention rates, data management, availability of supplies, commodities and tools, and knowledge gaps.

IDI-EKKP will support the recruitment of 80 critical cadres of health staff in the seven districts and establish seven laboratory hubs to facilitate EID sample collection and transportation.

All sites will submit daily reports on key program elements electronically to support effective monitoring and timely management.

IDI-EKKP will support the National Strategic Plan for HIV/AIDS (NSP) 2011/12-2014/15 objective of increasing access to ART from 57% to 80% by 2015. IDI-EKKP program will enrol at least 8.200 new clients and support 22,289 adults and children on ART in FY 2013, contributing to the overall national and PEPFAR target of 190,804 new clients and 490,028 individuals currently on treatment in the seven districts including Kibale, Kiboga, Kyankwanzi, Hoima, Bulisa, Masindi and Kiryandongo. This target is not a ceiling, it allows for higher achievements with continued program efficiencies. HIV positive pregnant women, TB/HIV patients, and key populations will be prioritised.IDI-EKKP will support the MoH roll out of Option B+ for eMTCT by supporting accreditation of 89 additional health facilities; training, mentorship and joint PMTCT/ART support supervision. IDI-EKKP 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 support TB/HIV integration to ensure early ART initiation for TB/HIV patients. IDI-EKKP will support integration of family planning and cervical cancer screening at facility level. High prevalence hard to reach and underserved areas in Buliisa and Hoima will receive community outreach services. IDI-EKKP will also target key populations using innovative approaches including setting up specialized services such as moonlight services.

IDI-EKKP will implement quality improvement initiatives for the ART framework including early initiation of ART eligible clients on treatment; improve adherence and retention; and monitor treatment outcomes and will support use of innovative, low cost approaches for adherence, retention and follow up such as phone/SMS reminders, appointment registers and flagging folders with alert stickers. Special focus will be placed on adherence and retention of women enrolled under Option B+. IDI-EKKP will increase access to CD4 for routine monitoring of ART clients in line with MoH guidance and will support the sample referral network in line with this national CD4 expansion plan. Clients access to CD4 will be monitored and reported quarterly.

IDI-EKKP will liaise with PACE and UHMG for provision and distribution of basic care kits and with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for other HIV commodities.IDI-EKKP will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda to support integration with other health and nutritional services. IDI-EKKP will also collaborate with other key stakeholders at all levels to provide required wrap around services.

The program is aligned to the NSP (2011/12-2014/15) and will work under the guidance of MoH/ACP and the Quality Assurance Department for trainings, ART/PMTCT mentorship and supportive supervision, will support and strengthen the national M&E systems and work within district health plans. In collaboration with the Health Systems Strengthening technical working group, IDI-EKKP will recruit 92 additional staff in the districts to meet the achievement of the targets.

IDI-EKKP will support the early initiation, adherence and retention of adolescents on treatment using expert peers and adolescent support groups. The youths will be provided with positive health 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.

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

IDI-EKKP will liaise with PACE and UHMG for provision and distribution of basic care kits and with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for other HIV commodities (cotrimoxazole, laboratory reagents).

IDI-EKKP will build the capacity of facility staff for accurate and timely reporting, forecasting, quantifying and ordering commodities.

IDI-EKKP will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda to support integration with other health, OVC and nutritional services. IDI-EKKP will collaborate with UNICEF and other key stakeholders at all levels for provision of required wrap around services.

The program is aligned to the NSP (2011/12 2014/15) and will work under the guidance of MoH/ACP and the Quality Assurance Department for trainings, ART/PMTCT mentorship and supportive supervision, will support and strengthen the national M&E systems and work within district health plans. In collaboration with the Health Systems Strengthening technical working group, IDI-EKKP will recruit 92 additional staff in the districts to meet the achievement of the targets.