Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013 2014 2015 2016

Details for Mechanism ID: 9879
Country/Region: Uganda
Year: 2012
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $2,933,588

The Strengthening Tuberculosis and HIV/AIDS Response in the Eastern Region (STAR-E) is a five-year USAID funded project awarded on March 9th, 2009 to empower communities in Eastern Uganda to respond effectively to the dual epidemic of HIV/AIDS and TB. The goal of the project is to increase access to, coverage of, and utilization of quality, comprehensive HIV/AIDS prevention, care, and treatment services within targeted districts in the eastern region. The specific objectives of the STAR-E project include: (1) to increase uptake of quality comprehensive HIV/AIDS and TB services at facility & community levels; (2) establish efficient & effective referral systems within and among health facilities and communities; (3) create awareness & demand for comprehensive HIV/AIDS and TB services; (4) coordinate USAID partners on the implementation of Lot Quality Assurance Sampling (LQAS) as a methodology of strengthening districts M&E systems; and (5) Health systems strengthening.Project coverage is in 12 districts of: Budaka, Bududa, Bukwa, Busia, Butaleja, Kapchorwa Pallisa, Mbale, Sironko, Kibuku, Bulambuli and Kween. The comprehensive HIV/AIDS service package includes: PMTCT, HTC, combination prevention; Adult/Pediatric Care and Treatment, TB/HIV, OVC and Nutrition/NACS services. STAR-E project works in partnership with district local governments; civil society organizations; networks of people living with HIV; and Ministry of Health.

Funding for Care: Adult Care and Support (HBHC): $381,839

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. STAR-E program will support the provision of care services to 24,813 as a contribution to the overall PEPFAR target of 812,989 HIV positive individual receiving a minimum of one clinical care service. 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. Specific attention will be given to key populations such as truck drivers, fishermen, commercial sex workers and MSMs. STAR-E will be expected to implement approaches to promote an effective CoR model and monitor key indicators along the continuum.STAR-E will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthen positive health dignity and prevention (PHDP); strengthen linkages and referrals using linkage facilitators; implement quality improvement for adherence and retention; pain and symptom management; and provide 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, CD4 coverage will be improved from 60% currently to 100% over the next 12 months. STAR-E 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.

STAR-E will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, liaise with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for other HIV commodities (cotrimoxazole, lab reagents). STAR-E will build the capacity of facility staff to accurately and timely report, forecast, quantifies and order commodities. In addition, STAR-E will work with USG partners such as PIN, SPRING, HealthQual, SIS, Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. Collaboration with other key stakeholders at all levels for provision of required wrap around services including family planning, etc. will occur.

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. STAR-E will work under the guidance of MoH AIDS Control Program (ACP) and Quality Assurance Department for trainings, mentorship and support supervision.

STAR-E will ensure gender awareness and issues are integrated in programs to ensure equitable access to care and treatment services such as identifying and addressing barriers that women and men may face in adhering to treatment or receiving ongoing care.

Funding for Care: TB/HIV (HVTB): $185,329

STAR-E will focus on supporting the GoU to scale up TB/HIV integration; and specifically the PEPFAR II goals of: (i) achieving a TB screening rate of 90% (731,690) of HIV positive clients in care; and (ii) initiating 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. STAR-E will contribute to this target by screening 22,332 HIV positive clients for TB; and 744 will be started on TB treatment.

STAR-E will improve intensified case finding (ICF); increase 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 i.e.GeneXpert and fluorescent microscopy. STAR-E will support MDR-TB surveillance through sputum sample transportation to Gene Xpert hubs and receipt of results at facilities.In FY13, STAR-E 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. STAR-E 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 using interventions such as: cough hygiene; cough sheds and corners; fast tracking triage by cough monitors; ensure adequate natural ventilation; etc.

The MOH/ACP and NTLP will be supported to roll out provision of Isoniazid Preventive Treatment (IPT), in line with the WHO recommendations.

In addition, STAR-E will work with USG partners such as PIN, SPRING, HEALTHQual, SIS, Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. STAR-E will collaborate with 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/AIDS and National TB Strategic Plan (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. STAR-E will work under the guidance of MoH AIDS Control Program, National TB and Leprosy Program and Quality Assurance Department in trainings, TB/HIV mentorship and support supervision. Additionally, STAR-E will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

Funding for Care: Pediatric Care and Support (PDCS): $33,951

STAR-E 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. STAR-E program will target 2,233 children less than 15 years of age, thereby contributing to the overall PEPFAR target of 74,555 HIV + children receiving at minimum one clinical care service. This is a subset of the umbrella care PEPFAR target.

STAR-E 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, 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. STAR-E will implement community mobilization and targeted activities such as Know your child status campaigns to identify more children. 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.

STAR-E 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, and 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 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. STAR-E will also support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

This program will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, liaise with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). STAR-E will build the capacity of facility staff to accurately and timely report, forecast, quantifies and order commodities.

STAR-E will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, SIS, and Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. STAR-E 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), support and strengthen the national M&E systems and work within district health plans. STAR-E will work under the guidance of MoH AIDS Control Program and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and support supervision.

Funding for Laboratory Infrastructure (HLAB): $101,652

During FY 2013, STAR-E laboratory services will be enhanced using both COP 2012 and project pipeline funds. The project will assist the ministry of health (MOH), working in collaboration with the Central Public Health Laboratories (CPHL), to establish three hubs in Kidera health center IV, Kapchorwa, and Pallisa hospitals, in Eastern Uganda. The major focus of STAR-E support will be 1) building CD4 capability, 2) strengthening specimen referral and result transmission network, 3) improved laboratory infrastructure, 4) improved facility level quantification and reporting to reduce CD4 reagent stock out and 5) assist the labs to implement the WHO recommended stepwise strengthening laboratory management towards accreditation with the aim to achieve a minimum of the World Health Organization three stars by September 2014. STAR-E will also work with the USAID/Strengthening Decentralization for Sustainability (SDS) project and district officials and relevant stakeholders to recruit five technicians and four technologists to ensure that all the three hubs have the necessary human resources required to run their laboratories at an optimal capacity. Funds for these additional human resources have been allocated through the SDS project. STAR- E will in addition, work with the Strengthening Ugandan Systems for Treating AIDS Nationally (SUSTIAN) project and Supply Chain Management Systems (SCMS) to ensure that CD4 machines have regular preventive maintenance to reduce equipment down time.

In addition to the three hubs STAR-E will also ensure that 17 facilities in Eastern Uganda that received PIMA point of care CD4 analyzers that the Ministry of Health procured during FY2012. The project will ensure that these sites continue to receive the necessary supplies through the national medical stores, and assist facilities to quantify need and project gaps in a timely manner.

Funding for Strategic Information (HVSI): $250,000

In COP 2012, STARE is funded to support SI Pivot 3 Strong/robust basic M&E systems at service delivery points and districts across 12 districts in Eastern Uganda. It aims at generating strategic information that serves to inform national policy and decision making, tracking program targets including outcome and impact measurements, evidence based programming and health systems strengthening in general. For routine project M&E activities, STAR-E will focus on strengthening the capacity of SI staff and strengthen systems for data collection, data processing, data analysis, presentation, interpretation and data quality improvement (Developing and Maintaining M&E Systems, including data quality assurance, Periodic Performance Reports) and Program evaluations. Strengthening HMIS will include indexing ART patients to eliminate double counting of patients being served at facilities and ultimately improve the quality of data being collected and, introducing the concept of the MoH electronic medical records to all health workers in the region, which will improve data storage, processing and analysis. Review meetings at district level to evaluate quarterly district performances and provide feedback for project improvement will support evidence based decision making. Data Quality Assessments along the reporting line will be conducted with GoU staff at least twice a year.In addition to the above region-specific SI activities, the STAR-E project will continue to coordinate all USAID district-based partners to implement and institutionalize the use of Lot Quality Assurance Sampling (LQAS) in 75 districts in all 75 districts, Facility assessments The results will be used by district local governments for performance measurement, monitoring, and resource allocation, with a special focus on the low performing HC IIIs, IVs and district hospitals. Funding for the LQAS coordination activities will be through the STAR-Project pipeline funds and the USAID Strengthening Decentralization for Sustainability (SDS) project that provides grants to the districts for these activities. Review of COP 12 determined that SI activities were underfunded and recommended increased support to SI. Collection of data for monitoring of the national roll-out of PMTCT Option B+ demands a few additional data collection tools, some minor revisions in the national HMIS form and some additional training and monitoring data acquisition and capture. USAID will shift $500K from HSS to SI for this purpose and implement the funds through STAR-E.

Funding for Biomedical Prevention: Voluntary Medical Male Circumcision (CIRC): $343,171

The revised COP 2012 strategic pivots for VMMC in the STAR-E region will focus on increasing coverage in 12 districts that have: 1) high HIV prevalence in the general population; 2) high HIV prevalence among women; and 3) low circumcision prevalence. Traditional circumcision is practiced in seven out of 12 districts in this region. VMMC interventions will focus on all eligible men (including adolescents) in the "catch up" phase to identify persons who are sexually active and at higher risk of acquiring HIV. Efforts will be made to target the rural hard to reach populations and communities particularly the fishing communities. Additionally, males aged 30 years and above will also be deliberately targeted. A minimum of 7,566 men will be circumcised by the STAR-E project.VMMC will be offered as part of the STAR-E comprehensive HIV prevention package, which includes: promoting delay of sexual debut; reduction in the number of sexual partners and being faithful; providing and promoting correct and consistent use of male condoms; providing HTC services; treatment of sexually transmitted infections and referring HIV+ men to appropriate care and treatment services. STAR-E will integrate VMMC services as part of the continuum of response (COR), contributing to access to reproductive health care for men; better engagement of men in care; and advocacy and better health seeking behaviors of their female partners for HTC, ANC, and eMTCT.To attain the above target, the STAR-E project will use multiple approaches to scale up VMMC that include: stand-alone sites with dedicated teams; integrated VMMC services within 20 health facilities; and outreaches and camps. STAR-E will use the Model for Optimizing the Volume for Efficiency (MOVE) as a means to optimize the efficiencies and increase the coverage especially in high volume static and outreach sites. A total of 58 service providers will be trained from Rakai Health Center, Walter Reed Project and IDI/IHK (public-private partnership). Quality improvement and assurance will be integrated as part of the minimum package of VMMC services through the implementation of national and international quality standards; and external quality assurance (EQA). The STAR-E project will build the capacity of providers to use the Non-surgical VMMC devices (PrePex) in the supported sites when approved by MOH.The STAR-E project will implement community campaigns to create acceptance and demand for VMMC through a mix of approaches including: 1) peer-to-peer strategy for interpersonal communication; 2) use of linkage facilitators to mobilize men; 3) community mobilization; and 4) use appropriate channels of communication including print and electronic mass media. Emphasis will be placed on increasing linkages of HIV+ clients from VMMC to care and treatment services as part of the COR.STAR-E will enhance monitoring and reporting through the MOH VMMC Operational Centre and HMIS tools and periodic data quality assessments (DQA). Data use at facility level will be strengthened through supporting M&E focused in-service training for health workers to foster evidence-based decision-making and program improvement.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $0

STAR E wil be offering comprehensive prevention package. They will offer age appropriate risk reduction messages to the young people in the community while complementing OP activities . No funds necessary for this activity.

Funding for Prevention: HIV Testing and Counseling (HVCT): $513,900

The STAR-E 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 Provider-Initiated Testing and Counseling; index client testing; and targeted HTC for key populations. This program will contribute to the continuum of response by linking clients to other health services including HIV Care and Treatment; TB; and social support services in the community with the aim of increasing demand and adherence for positive clients.

Program targets reflect the prioritization of districts with high HIV/AIDS prevalence and high unmet need. The project will target individuals in 12 districts bordering water bodies, including: Mbale, Budaka, Pallisa, Kibuku, Butaleja, Bududa, Busia, Bukwo, Kween; Kapchorwa, Bulambuli and Sironko. The target populations in these districts will vary depending on the district-specific prevalence of Most-at-Risk Populations and the general population. Based on existing surveillance data, the program will target 90,000 individuals in the population at-large. Programs will also target 9,741 MARPs which include: commercial sex workers and their clients and partners, fishing communities, uniformed forces, and long distance truck drivers.

HTC program activities shall be conducted in partnership with district local governments under stewardship of the Ministry of Health, recognizing that the scale-up of activities will require a medium-term commitment by the USG. PITC services will be provided in 141 health units covering all hospitals; Health Center IVs; and Health Center IIIs. Moonlight HTC will be provided in the border points in Busia to reach out to truck drivers and commercial sex workers. External quality assurance for HIV test validity will be implemented in all HTC service outlets at both community and facility level.

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.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $500,000

In the revised COP 12 the key pivots for the STAR-E project aim to ensure a balanced portfolio that will address comprehensive prevention needs of the primary target groups e.g. MARPS, including MSMs; the older population and youths through the implementation of high impact interventions in 12 districts in the eastern region. STAR-E will focus on addressing the key bottlenecks to increasing condom use that will include accessibility; availability; and acceptability of condoms among the target populations.Deliberate efforts will be made to promote condom use among key populations; sero discordant couples; and multiple partnerships in rural and urban populations. STAR-E will support condom distribution and promotion by increasing the number of distribution outlets at facilities; community level; fish landing sites; and rural hard to reach areas from the current 250 to 500 outlets. STAR-E will also engage with: (i) social marketing partners to increase distribution and promotion of condoms, (ii) the hospitality industry, particularly bars and hotels at fish landing sites and hot spots to ensure that condoms are readily available. An advocacy strategy will be developed to de-stigmatize condoms at all levels. The project has mapped out districts that are hot spots for MARPS that include commercial sex workers and their clients; long distance truck drivers; fisher folk ,uniformed service men; and internally displaced persons. The Hotspot marking through the PLACE methodology, will map out key populations including MSM in the various regions. This will help STAR -E tailor interventions to the identified key populations in this region.The MARPS interventions will focus on increasing perception of HIV risk associated with sex work, and multiple partnerships, strengthening PHDP among infected MARPs at facility and community levels, and scale up evidence-based behavioral interventions. STAR-E will target all clients in care & treatment with PHDP interventions. The PHDP interventions will aim at increasing knowledge of HIV status among PHLA and their partners, reducing the risk of HIV transmission and reducing HIV acquisition among person at high risk for infection.STAR-E will implement community campaigns to create acceptance and demand for condoms through: 1) peer-to-peer strategy for interpersonal communication; 2) use of linkage facilitators to mobilize men; and 3) use appropriate channels of communication including print and electronic mass media. The goal is to increase utilization and demand for condoms amongst the older population and youth including the MARPS and PDHP.Program monitoring and evaluation activities will be supported to strengthen the collection of data through national HMIS tools and to improve the technical quality of data through periodic data quality assessments. Data use at facility level will be strengthened through supporting M&E/SI focused in-service training for 80 of health workers.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $0

The PMTCT strategic goal for the STAR-E project during for COP 2012 is to contribute to ongoing national efforts of achieving virtual elimination of MTCT and keeping mothers alive through option B+ roll out. All the four PMTCT prongs will be supported in the 12 STAR-E supported districts that will be transitioned from Option A to Option B+ starting March, 2013. HCT services will be provided to 80,160 pregnant and lactating women in 141 health units that include five hospitals, 13 HCIVs, and 123 HC IIIs during FY 2013. A total of 2,760 HIV positive pregnant women will be identified, of whom 2,312 will be initiated on HAART for life and 408 will be provided with ARV prophylaxis. Infant ARV prophylaxis and EID will be provided to 2,720 exposed babies. To achieve the above, the STAR-E project will implement the following Ministry of Health and PEPFAR strategic pivots: 1) Improving utilization of eMTCT services to reach more HIV infected pregnant women as early as possible during ANC, labor/delivery, and post-partum periods. District service uptake will be based on district-specific PMTCT burden tables and targets that will guide the intensity of service delivery; 2) Decentralize treatment and Option B+ through the accreditation of all supported sites. The project will utilize the result of the site accreditation assessments to identify Option B+ training needs; procure equipment; print M&E tools, job aides, & Option B+ guidelines; train 980 service providers; and strengthen specimen referrals for CD4+ and EID. The transition plan of Option B+ in the STAR-E region will start initially in the 32 ART sites; and will gradually be spread to the remaining 109 Non-ART PMTCT sites. Family Support groups will be established in all 141 health units to enhance retention. The FSGs will meet monthly to receive adherence counseling and psycho-social support; supported disclosure; IYCF counseling; EID; FP counseling; Couple HTC; repeat-testing; ARV refills; and link negative male partners to VMMC if required. The project will support the establishment of a PMTCT linkage facilitator per site and provide performance-based grants to Community-based organizations to enhance facility-community linkages i.e. follow-ups; facility referrals; and adherence support. 3) The project will intensify tracking of mother-baby pairs at facility & community levels for effective Option B+ monitoring and program management. Mobile phone technology will be used to remind mothers & their partners on appointments; EID results; and ARV adherence. Home visits will be conducted to trace those who are lost to follow-up using VHT and/or midwives.4) STAR-E will enhance the quality of PMTCT services through quarterly joint support supervision & mentorships at all PMTCT/ART sites. Site level support will entail cohort reviews; adherence rates; retention rates; data management; availability of supplies (commodities, HIV test kits, tools, job aides & ARVs); and addressing of existing knowledge gaps on Option B+.5) STAR-E will integrate voluntary and informed family planning (FP) services based on respect; womens choices; and fulfillment of their reproductive health rights. FP sessions will be integrated within PMTCT trainings for all service providers. FP counseling; education, and information will be provided to all women during ANC, Labor & Delivery, and postnatal periods; and in Care and treatment settings in collaboration with existing FP partners.

Funding for Treatment: Adult Treatment (HTXS): $617,899

STAR-E will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. STAR-E program will enroll at least 4,810 new clients and support 12,655 adults 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.STAR-E will support the MoH roll out of Option B+ for eMTCT through the following activities: accreditation of health facilities in line with MoH accreditation scale-up plan; training, mentorship and joint PMTCT/ART support supervision. It 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. STAR-E will support RH integration including family planning and cervical cancer screening at facility level through provision of the services or referrals.Targeted community outreaches in high prevalence hard to reach and underserved areas will be conducted. STAR-E will also target key populations using innovative approaches including setting up specialized services; such as moonlight services.STAR-E 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, appointment registers, alert stickers will be supported.Special focus will be placed on adherence and retention of women enrolled under Option B+; and increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. STAR-E 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.This program will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, liaise with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). STAR-E will build the capacity of facility staff to accurately and timely report, forecast, quantifies and order commodities. In addition, STAR-E will work with USG partners and other key stakeholders for provision of 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. STAR-E will work under the guidance of MoH AIDS Control Program and Quality Assurance Department in trainings, ART/PMTCT mentorship and support supervision.STAR-E will ensure gender awareness and issues are integrated in programs to ensure equitable access to care and treatment services such as identifying and addressing barriers that women and men may face in adhering to treatment or receiving ongoing care.

Funding for Treatment: Pediatric Treatment (PDTX): $5,847

STAR-E will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. This program will enroll at least 962 new HIV positive children and support 1,891 children on ART by APR 2013 and will contribute to overall national and PEPFAR target of 39,799 new clients and 64,072 children current on treatment.IN FY13, STAR-E 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 years in line with the national treatment guidelines.

STAR-E will support the early initiation, adherence and retention of adolescents on treatment using expert peers and adolescent support groups. They will be provided with PWP /PHDP 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.The program will support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

STAR-E will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Furthermore, liaise with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). STAR-E will build the capacity of facility staff to accurately and timely reports, forecast, quantify and order commodities.

In addition, STAR-E will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, SIS, and Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. STAR-E 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), support and strengthen the national M&E systems and work within district health plans. STAR-E 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.

Key Issues Identified in Mechanism
Addressing male norms and behaviors
Increasing gender equity in HIV/AIDS activities and services
Increasing women's access to income and productive resources
Increasing women's legal rights and protection
enumerations.Malaria (PMI)
Child Survival Activities
Mobile Populations
Safe Motherhood
Tuberculosis
Family Planning