UNHCR is a UN agency mandated to provide international protection to refugees, asylum seekers, and Internally Displaced Persons. The project will be implemented in Kyaka II (Kyegegwa District), Nakivale and Oruchinga Refugee settlements (Isingiro District). The beneficiaries include 74,421 refugees and 70,000 nationals living in and around the settlements.

Under Abstinence, Be faithful and Condom use, 1 youth centre will be established supported by the community peer groups, behavior change communication will be done through religious leaders, peers educators, puppetry, IEC, and mass media. Other prevention will support Universal precautions, strengthen the SMC program through staff training and equipment and working with traditional circumcisers. Interzonal drama and sports competitions during which period HIV/AIDS themes will be discussed and condoms distributed to the right group. The number of persons reached through small group messages will be addressed by a network of 102 peer educators in the 3 settlements. As part of the HIV dissemination teams, religious leaders will be supported with bicycles to disseminate HIV/AIDS information during sermons but also during home visits.

The day-to-day monitoring of the project is done by the health coordinators of the implementing partners, support supervision is provided by both UNHCR and District Health Office. The activity outputs and indicators are generated on a monthly basis through the UNHCR Health Information System, monthly situation reports, and support supervision reports. Planning and implementation of the project is done together with the beneficiaries. Building the capacity and working with community own resource persons and volunteers is part and parcel of project implementation.

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. UNHCR program will support the provision of care services to 1,000 individuals as a contribution to the overall PEPFAR target of 812,989 HIV positive individual in care and support services. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to refugees. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. UNHCR will be expected to implement approaches to promote an effective CoR model and monitor key indicators along the continuum. UNHCR will work in II (Kyegegwa District), Nakivale and Oruchinga Refugee settlements (Isingiro District).

UNHCR 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. Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation in line with MoH guidance. UNHCR 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.

UNHCR 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). UNHCR will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities.

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

Support care including OVC (Achievement: 537 OVCs were profiled of which 406 were each supported in primary school with bags, books, pens, shoes, 2 pairs of uniforms (with 3 emerging the best candidates in the Kyegegwa district), 50 benefited from the secondary school scholarships, 79 foster families have so far been supported with Income generation activities as means of encouraging fostering of OVC by families but also to improve the familys wellbeing. 30 caregivers trained in comprehensive HIV management and 1 laptop computer was procured to support the identification and documentation of all orphans and vulnerable children by community services department in Kyaka II. Parts of the OVCs supported are 50 Secondary school scholarships that are benefiting 25 boys and 25girls. The other OVC comprehensive program areas are adequately covered by UNHCR.

All the activities under a specific program were developed guided by the existing gaps, various national policies, strategic plans, priority plans and guidelines and are therefore linked to the various program areas of Elimination of Mother to Child Transmission of HIV, HCT, OVC, Abstinence and Be faithful, Other prevention, TB and HIV.

TB/HIV (100% of HIV positive persons are screened for TB and vice versa; 538 persons living with HIV are accessing services) - 450 minimum packages consisting of a jerry cans, water treatment chemicals, LLITNs, drinking water storage containers for each of the HIV positive clients, 1 CD4 machine is in place for patient monitoring, 7 active post-test clubs were supported with revolving income generation (piggery and seedlings) and IEC materials so as to disseminate HIV/AIDS related information. Routine TB quality control is supported by the Ministry of Health while Integrated TB and HIV services are being carried out through active case finding among HIV positive and those on TB treatment. Families of persons with TB are screened using integrated case finding form. TB/HIV co-morbidity management training also held for 30 health workers. In order to improve the quality of care, an assortment of drugs for opportunistic infections was procured to support the services during the drug stock outs from both the national medial stores and UNHCR.

All the activities under a specific program were developed guided by the existing gaps, various national policies, strategic plans, priority plans and guidelines and are therefore linked to the various program areas of Elimination of Mother to Child Transmission of HIV, HCT, OVC, Abstinence and Be faithful, Other prevention, TB and HIV.

Sexual and behaviour risk prevention (Achieved 9299, (Target 9000): Many community opinion leaders were trained to transmit the information in their constituencies. These include: 48 teachers (38 males; 10 females) and 33 community workers trained on general HIV prevention, 25 peer educators trained and supported to disseminate HIV/AIDS and SGBV information, 33 community leaders (32 males; 1 female) and 76 Religious leaders (70 males; 6 females) were trained on general HIV/AIDS and new initiatives to address control HIV infections. 35 influential community members trained on the revised referral pathway to enhance timely referral of SGBV cases for medical care. 4 AIDS clubs formed in primary schools and 1 life skills club formed in Bujubuli secondary this was further followed by procurement of an assortment of Sports equipments procured to support HIV information dissemination through sports, 390 t-shirts distributed to post test clubs, drama clubs, PLHIV and school aids. 500 small posters distributed to the community and health centers and 82 sex workers were profiled and followed up on a quarterly basis with screening for HIV, STI, family planning and condom refills. The Multi functional team that addresses SGBV and sex work interventions was formed in Kyaka II and underwent orientation. This team is responsible for addressing the medical, social and protection concerns of sex workers.

All the activities under a specific program were developed guided by the existing gaps, various national policies, strategic plans, priority plans and guidelines.

HIV Counseling and Testing - (Achieved 5319 (Target 6000) 1 counselor, 1 laboratory staff, 2 motorcycles to support outreaches and SGBV response in Kyaka II, 24,500 HCT kits and consumables were procured, 114 t-shirts were printed as motivation packages for couple counseling and testing and IEC (10 billboards, 2 banners, 500 posters, 300 t-shirts) to increase demand creation. The project will support daily HCT outreaches to the refugee settlements and surrounding host population as part of achieving universal access to HIV counseling and testing. To make these outreaches integrated with other maternal and child health services, 2 outreach tents and tables were procured so as to start a one stop centre during the outreaches.

All the activities under a specific program were developed guided by the existing gaps, various national policies, strategic plans, priority plans and guidelines and are therefore linked to the various program areas of Elimination of Mother to Child Transmission of HIV, HCT, OVC, Abstinence and Be faithful, Other prevention, TB and HIV.

Other Prevention: The project support procurement an assortment of laboratory reagents and drugs for sexually transmitted infections, universal precaution commodities like gloves (surgical & disposable), syringes and needles, mackintosh. 15 health workers were trained on universal precautions, 3 health workers received a certified training in Safe Male Circumcision at Rakai Health Sciences Program to roll-out SMC package in Kyaka II refugee settlement. 220,824 male condoms were distributed during the period and 25 discordant couples and followed them up with regular counseling and testing. 296 safe blood units were transfused to the deserving patients and PEP kits were procured for the clinical management of rape survivors.

All the activities under a specific program were developed guided by the existing gaps, various national policies, strategic plans, priority plans and guidelines and are therefore linked to the various program areas of Elimination of Mother to Child Transmission of HIV, HCT, OVC, Abstinence and Be faithful, Other prevention, TB and HIV.

EMTCT - Achieved 2,069 (Target- 1700) 3 midwives were recruited, 7 groups of HIV positive mothers formed that provide the follow-up, 22 health workers in infant and young child feeding, 34 peer educators recruited who disseminate HIV/AIDS messages through peer-to-peer approach, distribute condoms, and help to profile the sex workers in the settlement., 37 positive women supported with food stuffs, and 1 maternity ward extension with a minor theatre for safe male circumcision. Procurement of supplementary pediatric ARV formulations during the case of raptures in the national supply system. All family planning options were procured to improve access to family planning services for both HIV positive couples and the general population and family planning outreaches arranged in the community. As part of improving maternity services, staff received a certified training in EMoNC using the ALARM approach as well as postpartum insertion of IUCD and other long term methods of contraception.

All the activities under a specific program were developed guided by the existing gaps, various national policies, strategic plans, priority plans and guidelines and are therefore linked to the various program areas of Elimination of Mother to Child Transmission of HIV. The day-to-day monitoring of the project is done by the health coordinators of the implementing partners, support supervision is provided by both UNHCR and District Health office. The activity outputs and indicators are generated on a monthly basis through the UNHCR Health Information System, monthly situation reports, and support supervision reports. Planning and implementation of the project is done together with the beneficiaries. Capacity building and working with community own resource persons and volunteers is part and parcel of project implementation. Some services are linked to the government services, while others are integrated into the ongoing UNHCR activities to minimize duplication as a means of ensuring sustainability. The implementation will take place in 2 districts of Kyegegwa and Isingiro that covers three refugee settlements with about 74,421 refugees and 70,000 nationals living in and around the settlements. Although the entire refugee community and surrounding national community is targeted, specifically, youth in and out of school, women of the reproductive age group, pregnant women, their spouses and their unborn & newborn babies, commercial sex workers, persons living with HIV/AIDS (family planning) and men in the reproductive age group.

Although the budget is zero, these activities will be carried out using the acceleration money received.

UNHCR will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. UNHCR program will enroll at least 1,000 new clients and support 900 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. Priority will be given to enrolment of HIV positive pregnant women, TB/HIV patients, and key populations. UNHCR will work in II (Kyegegwa District), Nakivale and Oruchinga Refugee settlements (Isingiro District).

UNHCR will support the MoH roll out of Option B+ for eMTCT through the following activities: accreditation of xxx additional health facilities; training, mentorship and joint PMTCT/ART support supervision. UNHCR 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. UNHCR will support RH integration including family planning and cervical cancer screening at facility level through provision of the services or referrals.

UNHCR will implement: 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+.

Focus will be placed on increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. UNHCR 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.

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). UNHCR will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities.

In addition, UNHCR will work with USG partners and other key stakeholders for provision of required wrap around services.