The project is being implemented in Kampala district which is now administered under a new legal frame work the Kampala Capital City Authority (KCCA) replacing the old KCC administrative structures. KCCA retains the 5 divisions of Central, Nakawa, Makindye, Kawempe, and Rubaga and is directly responsible for 10 health units.

Kampala has a day time population of over 2,300,000 people but has no district hospital; therefore the National Referral Hospital at Mulago acts as the district hospital. The chronic congestion at Mulago Hospital in many ways compromises its ability to function as a national referral care facility. Building and upgrading the capacity of the ten KCCA clinics will ultimately contribute to the decongestion of Mulago hospital.

The Goal of the KCCA-IDI project is to scale up comprehensive HIV/AIDS through the 10 KCCA health facilities.

A sustainability plan has been developed where services will be transitioned to KCCA management in a phased manner with transitional oversight by the project STTAT staff. The project will strengthen health systems through management and leadership capacity building at both the health facility and district level. IDI will facilitate continuous mentorships and regular support supervision of the field activities by the technical experts and project head office.

Two vehicles have been procured for day-to-day coordination and linkages between the project office and the different health facilities. The vehicle for the DDHS office facilitates headquarters in providing support supervision to the field staff and bridges logistical gaps facilitates HMIS linkages and carters for other transport related contingences at KCCA headquarters.

IDI supports the delivery of HIV care and treatment services at 7 ART accredited facilities (Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, and Kawempe). In FY 2011, 15,825 adults were provided with at least one clinical service representing 107% of the set target (14,800 adults). Out of these, 6,911 individuals were active on ART (116% of 5,968 target).

The project will continue to improve the capacity and conditions of 8 KCCA health facilities to provide comprehensive HIV/AIDS care and treatment. In FY 2012, comprehensive HIV/AIDS care and treatment services will be offered at Kitebi HCIII, Kawaala HCIII, Komamboga HCIII, Kawempe HCIV, Kiruddu HCIII, Kisenyi HCIII, Kiswa HCIII and Kisugu HC III health facilities. In line with training needs, KCCA health care workers will be trained in comprehensive HIV/AIDS care while mentorship of trained health workers by Short Term Technical Assistance Teams (STTAT) will continue. Availability and use of national treatment guidelines will be ensured and standard operating procedures and evidence based clinical protocols will be developed and utilized. Continuous professional development through CME sessions involving active participation of KCCA health care workers will be supported.

The specialist technical teams will continue to provide mentorship and technical oversight and expert support in managing difficult or complex cases. KCCA health care workers will be availed access to AIDS Treatment Information Centre (ATIC) of IDI as an added support to handle most of the complex ART related issues.

In FY 2012 7,300 new individuals will be enrolled into care through KCCA facilities and a total of 25,000 individuals will be receiving at least one clinical service by the end of FY 2012. Of these, an average of 450 patients will be enrolled on ART per quarter making a total of 11,000 patients active on ART across the project supported facilities. Other patients from IDI PCT (3000 both chronic care and ART) and MJAP (900 on ART) will be added on the project. In addition following PEPFAR partner rationalization, IDI will take over management of 2 Private Not for Profit Organizations PNFPs (Hope Clinic Lukuli and Kawempe Home care) previously supported by SUSTAIN.

The project is committed to scale up care and treatment services so as to improve the quality of life of PLHIV while emphasizing the sustainability of these services within the government structure. The scale-up of quality comprehensive HIV/AIDS services in the KCCA facilities is intended to contribute towards the national prevention and control of STIs/HIV/AIDS strategies and key interventions as stipulated in the HSSP III (2010/11- 2014/15) and specifically to the national indicator of The proportion of people who are on ARVs increased from 53% in 2009 to 75% by 2015 among adults and from 10% to 50% in children less that 15 years of age.

FY 2011 had a small budget for OVCs and subsequently not much was available for this vulnerable group. With increased funding in FY 2012, interventional strategies to help families and communities to care for children living with and affected by HIV/AIDS will be pursued. Specific support will include: caregiver training, targeted nutritional support, medical care and economic empowerment through training in income generating activities. Linkages and partnerships with organizations that provide food (packages) and food security will be pursued. Other linkages will include education life skills and vocational training, child protection, legal aid services.

In FY 2012 the projects will identify an estimated number of 1,250 OVCs to be provided with 3 or more OVC core program areas while an extra 500 will be provided 1 or 2 CPAs from the supported health facilities. The core program areas for support are health care, therapeutic feeds for malnourished children and economic empowerment through training and facilitation on income generating activities. The project will continue providing psycho social and spiritual support in groups and individually during treatment and care as well as facilitating peer support group meetings, care giver meetings and adolescent meetings.

These IDI efforts are consistent with the strategies for achieving goal three To mitigate social, cultural and economic effects of HIV and AIDS at individual, household and community levels and specifically geared towards contributing to objective 12 To increase provision of quality psychosocial support to PHAs, OVCs, PWDs and other disadvantaged groups affected by HIV and AIDS by 2012 and Objective 15 Increase access to basic entitlements for PHAs and OVCs of the National HIV/AIDS Strategic Plan.

TB/HIV co-infection management remains a key component of HIV/AIDS care and treatment at all supported KCCA facilities. In FY 2011, SOPs on the management of patients with or suspected TB were finalized and disseminated to all KCCA health care workers. These complement the 2010 national TB management guidelines. 20 KCCA staff including TB focal persons at each of the health facilities have been trained in the management of TB/HIV co-infection. The TB focal persons are supporting the rest of the KCCA staff in implementing proper management of TB/HIV co-infection including data management, infection control procedures to prevent naso-comial transmission.

Furthermore, a comprehensive TB management plan that involves working with the existing NTLP structures to support TB data management and TB drugs supply chain mechanisms has been drawn and all individuals attending HIV clinics in FY 2011 were screened for TB.

Uganda is yet to attain the global case detection of 70% and treatment success target of 85%. Case detection rates in Uganda remain low at 44% compared to global rate of 61% and have been declining over the last decade with only 1/3 of those who are initiated on treatment are reported cured. Infrastructural challenges including lack of lab equipment coupled with critical human resource gaps limit effective implementation of intensive case finding and TB diagnosis.

Treatment success in Kampala remains low within a scenario of poor patient follow up, poor adherence to treatment and low completion rates, stock outs of supplies and medications on a backdrop of manpower shortages. Mitigating measures have included training of KCCA HCWs in HIV/TB management, support by project STTAT, provision and maintenance of equipment (microscopes, Biological Safety cabinets) and strengthening TB supply logistics and HMIS systems. Other areas of focus will include TB/HIV integration, intensified case finding by screening all patients in outpatient departments for signs and symptoms of TB, screening of all HIV positive patients for TB at every visit and screening of all HCT clients for TB, prevention of nosocomial transmission of TB to patients and staff, Support supervision and mentorship of KCCA staff in TB/HIV co-infection management, implementation of national guidelines and standard operating procedures for treating patients with HIV/TB co-infection, integrating HIV counseling and testing services into TB care, and screening of eligible categories of patients for multi drug resistant TB.

IDI-KCCA project will continue to mentor HCWs to ensure provision of OI prophylaxis to 100% of TB/HIV co-infected patients, treatment for 100% of TB/HIV co-infected cases, and proper monitoring of TB case holding. IDI-KCCA project will encourage TB teams to utilize existing community structures for the promotion of community-based DOTs (CB-DOTs) strategy to improve treatment outcomes. The project will support personnel at KCCA to oversee this component under the Kampala TB Zone.

The interventions emphasized in TB/HIV co-management are in line with the strategies goal two of the National HIV/AID Strategic Plan To improve the quality of life of PHAs by mitigating the health effects of HIV/AIDS by 2012  and specifically to objective 7 To increase access to prevention and treatment of OIs including TB.

In FY 2011, the project provided support towards pediatric care and support services in 7 of the supported ART accredited sites (Kawempe, Kiruddu, Kiswa, Kawaala, Kitebi, Kisenyi and Komamboga). Komamboga HC III only commenced pediatric care in the third quarter of FY 2011). Children and adolescents (1,739) make up 10% of the total number of all clients served by KCCA health facilities.

In FY 2011, 1,336 infants were done virological (PCR 1,314) and immunological (ELISA - 22) tests within 12 months of birth. Among these, 86 were HIV positive giving a prevalence of 6.4% across the facilities.

Building the capacity of the facilities to provide pediatric care and treatment as part of a family care model of HIV/AIDS care delivery will continue as a priority in FY 2012. By September 2012, these facilities will be able to offer pediatric care and treatment services with minimal or no IDI support.

Strategies have been put in place to ensure that DBS samples for EID are collected routinely from all HIV exposed infants, HIV positive infants are enrolled into care and that pediatric ART formulations are available. KCCA health workers will be trained in pediatric HIV/AIDS care and mentorship by the technical assistance teams (STTAT) of all trained staff will continue. The pediatric care specialist will provide technical oversight and support for handling complex or difficult cases. The nutritional status of all the children will be assessed and we will continue to seek for partners to provide nutritional support. It is expected that 80% of HIV positive mothers will return with their new born babies and all their infants (new born babies) will be tested for HIV within 12 months of birth and all those who return within two months of birth will be started on CTX prophylaxis.

A target of 2,500 (10%) out of a total of 25,000 individuals reached and provided with at least one clinical service by the project in FY2012 will be children and adolescents.

In continuing to provide and ensuring the scale of pediatric care and treatment services, the strategies used and achievements will contribute towards the national prevention and control of STIs/HIV/AIDS strategies and key interventions as stipulated in the HSSP III (2010/11- 2014/15) and specifically to the national indicator of The proportion of people who are on ARVs increased from 53% in 2009 to 75% by 2015 among adults and from 10% to 50% in children less that 15 years of age.

Since the inception of the project, support is being geared towards strengthening the coordination function of CPHL & support establishment of a system to measure and monitor the development of KCCA labs. This will be based on agreed national standards to refine the National Laboratory Standards and Accreditation system in KCCA.

The plans for the second year are for Kiswa lab to be upgraded from current district laboratory accreditation level 3 to at least level 4 and develop a second lab to the same district level by year 4 of the project and upgrading of other KCCA health centre III labs from the current Health Centre III national accreditation Level 2 to at least level 4 by year 4 of the project.

Accreditation of all the KCCA labs will ensure that the minimum tests required for HIV care including ART and TB are available at all the supported KCCA sites and are done according to national standards.

A laboratory network will be strengthened through established linkages and sample referral systems between laboratories to ensure that all the supported KCCA health facilities have laboratory tests required by HIV and TB care programs for adults, pregnant women and children (Chemistry tests, blood counts, CD4 counts, EID, TB smear microscopy and TB DST for suspected TB drug resistance, and Viral Load test for suspected ARV drug resistance).

A District QA/QC system (that covers all the supported laboratories) coordinated at a Kiswa laboratory and linked to the CPHL QA/QC coordinating office will be established linked to the Association of Reference laboratories and QA/QC partners in order to harmonize QA/QC activities for HIV testing, TB smear microscopy, CD4 cell counts and malaria.

The WHO/CDC laboratory strengthening checklist used in the SLMTA approach shall continue to be used to measure progress in performance of the labs towards attaining the different accreditation levels. This highlights the different areas of quality to be improved based on the entire Laboratory Quality Management System (LQMS).

In FY 2012, the project will focus on consolidating the gains of the past year by developing linkages with didactic training, mentorship and support supervision will continue to be used as the main tools for personal capacity development.

The six building blocks of HSS (service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership/governance) provide a useful framework to guide the strengthening of the KCCA health system. IDI will holistically address HSS using the capacity building pyramid model which constitutes a continuous improvement mechanism that looks at the relationships between the HSS blocks while coordinating feedback linkages to ensure a holistic and continuous systems improvement.

a) Human Resources (HR): In some facilities staff categories, as high as 50% of the established positions are unfilled and some staff categories that are necessary for full implementation of the HIV/AIDS service continuum like counselors are nonexistent. Even where the establishment is full, the work load is beyond capacity negating novel strategies like task shifting and task sharing. The project will deploy Short Term Technical Assistance Team (STTAT) to boost the KCCA HR capacity for service delivery as KCCA is supported to recruit additional health staff.

b) Training of HCWs to improve knowledge, skills and attitudes: IDI will support training of KCCA health care workers in Comprehensive HIV/AIDS care and management, Supply and logistics management, PMTCT-EID management, TB/HIV co-management; ART Monitoring tools (HMIS).

c) Generating community demand for health care and strengthening referrals: This has been evident and successful in MMC and HCT thematic areas and will be extended to other program areas.

d) Strengthening the Supply chain and drug logistics systems: Provision of buffer stocks and improvement of health facility infrastructure for dispensing and storage.

e) Health information: To enhance data collection and management, the project will put in place measures such as availability of tools to ensure that clinics are collecting data from HCT (RCT, VCT, and PITC), pre-ART and ART delivery. The data collected will enable the KCCA health facilities effectively monitor HIV positive patients. Strategies to be deployed to ensure data management systems are in line with the national HMIS include: (1) Providing training and ongoing supervision on collecting data according to MoH HMIS guidelines including provision of skills to analyze and use data in real time; (2) ensuring that MoH HMIS data collection forms are always in stock at targeted facilities; (3) Establishing functional internet linkages at all facilities to facilitate easy retrieval of information, analysis and submission of reports channeled along the GoU information flow system.

f) Sustainability, Governance and Resource mobilization: KCCA still has insufficient capacity to manage vital, complex HIV/AIDS services without external support. The structures for coordination and resource mobilization in the district (the District AIDS Taskforce, the District AIDS Committee, and the district AIDS partnership) need further strengthening to become fully effective. The project will address the management structures at KCCA including; governance, resource mobilization, supervision and grants management.

g) Finance: Baseline financial management assessment at KCCA is a prerequisite for the sub granting mechanism. Plans are under way to audit KCCA to assess its ability to manage the sub-grant. In FY 2012 IDI will support KCCA to establish an appropriate financial management system.

In January 2010, the Ministry of Health (MoH) launched the Safe Male Circumcision policy to guide the integration of SMC services in Ugandas national health system. This followed a recommendation the WHO that male circumcision be considered as part of a comprehensive HIV prevention package.

Safe Male circumcision (MMC) is being offered as part of a comprehensive HIV prevention package, which includes: promoting delay of sexual debut, abstinence and reduction in the number of sexual partners; providing and promoting correct and consistent use of male and female condoms; providing HIV testing and counseling services; and providing services for the treatment of sexually transmitted infections.

Within IDI-KCCA CoAg, Safe Male Circumcision under the acronym AMAKA is an initiative started in late March 2011 (targeting male adults >13 years of age) and contributes to the reduction of HIV incidence in Kampala district. In FY 2011 the AMAKA project achieved the following milestones:

1) Building Staff Capacity in MMC Service Delivery through Training

The AMAKA INTIATIVE aims at building the capacity of KCCA to provide MMC services with a specific objective to circumcise 5000 men.

2) In order to achieve this, AMAKA Initiative recruited 24 staff dedicated to MMC and based in the Kisenyi Health centre. A patient waiting shed at Kisenyi HC IV was remodeled to create 4 MMC operating theatre bed spaces and these were equipped with basic equipments and supplies. This will be continued in FY 2012.

3) Sensitization and Empowerment of Kampala Communities About MMC

Creating acceptance and demand for MMC in Kampala has been generated through a series of community campaigns based on information from WHO, UNAIDS and the Uganda National Communication Strategy on Safe Male Circumcision. In FY 2012, IDI will employ both media campaigns and person to person message packaging to target men. IDI plans to engage community mobilisers who will target localities with high numbers of men like markets, taxi parks, Boda Boda stages.

4) Circumcisions: In order to achieve the required year one target in view of the delayed start up in FY 2011, Public Private Partnerships with International Hospital Kampala (IHK) to carry out circumcisions were entered into in consultation with CDC. IHK started circumcisions on 9th April 2011 and 3,000 were done over the period 9th April 5th August 2011 surpassing projected targets in a timely manner and creating unprecedented demand for MMC services. In FY 2012, MMC will continue to be a strong focus area of IDI-KCCA project in the prevention strategies. Public Private Partnerships with (IHK) to carry out circumcisions will continue but the majority of the circumcisions will be carried out by IDI/KCCA.

A total of 8,400 circumcisions are planned for FY 2012. The remodeled circumcision centre at Kisenyi and proficient staff will be used to train KCCA HCWs and serve as a centre of MMC excellence. It is proposed that services will be extended to other KCCA HFs using the outreach model. This will be done together with the KCCA HCWs as part of capacity building effort.

The projects MMC interventions in Kampala district are geared towards contributing to goal one of Uganda National HIV/AIDS Strategic Plan To reduce the incidence rate of HIV by 40% by the year 2012 and to objective 5 To promote use of new prevention technologies and approaches proven to be effective.

In FY 2011, IDI supported the provision of facility based HCT in 8 KCC Clinics of Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, Kawempe and Kampala Dispensary using RCT/PICT as the main approach. Community outreaches were supported for the catchment areas of Kawempe and Kisenyi health centre.

The major success factors for HCT that will be promoted included; the integration of RCT/PICT approaches to HCT at the OPD and ANC points in the health facilities; the integration of innovative models in which opinion leaders and Friends/client councils mobilize communities to utilize HCT services; regular uninterrupted supply of HIV test kits to the KCC facilities; mentorship in PICT provided to KCC health care workers by the project technical assistance team members and integrating HCT services into routine service delivery thus reducing missed opportunities for HCT.

HCT is a critical bridge to HIV treatment, care and support services. In FY 2012, several HCT approaches will be adopted including the facility based provider-initiated HCT (PICT) in all the 8 sites and HCT outreaches within facility catchment areas as a way of bringing services nearer to the people. Challenges anticipated include; few health workers mentored in PICT, a difficult working environment including limited space for needed privacy. With improvements in human resources, technical and administrative capacities and with increased community awareness of services at KCCA about 50,000 individuals will be reached. These will include 35,000 clients accessing HCT through the PITC (adults and children at OPD and other RCT corners), 13,000 clients reached through community outreaches, and another 2500 clients through HIV testing of family members of HIV positive index clients.

In FY2012, HCWs will receive training, mentorship and regular supportive supervision. Each facility will be supported to conduct one targeted community HCT on a monthly basis. Special HCT events will be conducted targeting MARPs (fisher folk, the uniformed personnel, couples), youth in schools and teachers, bodaboda cyclists, market vendors. Other HCT activities will be arranged in partnerships with community based organizations (community-driven adhoc HCT). Community opinion and local leaders will be engaged in mobilizing communities/populations to seek HCT activities.

HCT commodities and supplies including data collection tools (HCT and pre-ART register, HCT client cards, daily consumption logbook for HIV test kits), HIV test kits and test tubes supply chain will be maintained at all facilities, and quality control activities will include internal and external controls, self-reflection and client interviews and data collection and utilization of HCT data will be strengthened.

The project will ensure that patients who test positive are linked into care. Care linkage activities will include; Conducting a survey to explore the factors contributing to low linkages, mapping of HIV/AIDS service providers who refer patients to KCCA facilities and vice versa, strengthening the documentation system of referrals and supporting KCCA to adopt models of care that will address long waiting times in the clinics.

PMTCT implementation in Kampala district is spearheaded by PREFA. Through coordinating PREFA & IDI activities, PMTCT services at KCCA facilities of Kitebi HCIII, Kawaala HCIII, Komamboga HCIII, Kawempe HCIV, Kiruddu HCIII, Kisenyi HCIII & Kiswa HCIII will be strengthened as part of the comprehensive HIV/AIDS care package. IDIs PMTCT activities will include clinical assessment of mothers for eligibility for ARVs; laboratory assessment including CD4 testing; follow up of HIV positive mothers on ARVs; EID & follow up of exposed infants.

In FY 2011 1,960 mothers were assessed for eligibility for ART; 865 HIV positive pregnant mothers received ART & a total of 609 infants of HIV infected mothers received ARVs. With introduction of new PMTCT guidelines, the project supported short term training of 42 HCWs on PMTCT-EID to enable the provision of PMTCT services including follow up of exposed infants according to the recommended guidelines.

IDI will continue supporting PMTCT activities at KCCA facilities as part of the comprehensive services. Mentorship of KCC health care workers will continue & the care & treatment specialists will continue to provide technical oversight through support supervision. Linkages between ANC & other HIV/AIDS care service points including the ART clinic will be strengthened.

IDI will receive funds as part of the PMTCT acceleration plan to implement all the 4 prongs for PMTCT that will include:

Prong 1: Prevention of HIV in Women. All pregnant & lactating women & their partners will be tested for HIV. IDI will strengthen interventions to keep all HIV negative pregnant & lactating women HIV negative & Promote equity & an enabling environment in the KCCA clinics for pregnant & lactating mothers.

Prong 2: Prevention of Unwanted Pregnancies among HIV+ Women. In FY 2012 IDI will Increase FP uptake through MNCH & HIV clinics within all the KCCA clinics. This will be done through creation of demand for FP services through IEC, advocacy, & provision of correct information to dispel myths & misconception about FP, benefits of FP, interaction of some FP methods with ARVs & support for sero-discordant couples. IDI will work together with RH to provide FP services (commodities including reversible & non-reversible long term methods, scale up distribution points, Integration; strengthen HW capacity to provide Long term FP method & address supply chain management issues in addition to strengthening Management & Surveillance systems for FP.

Prong 3: PMTCT Scale up PMTCT Services in the KCCA facilities integration of services, expanding coverage, supporting human resource & Infrastructure. Accelerate scale up & uptake of more efficacious regimens (MER) to all HIV positive pregnant women & their infants in the KCCA clinics & roll out the new guidelines

Prong 4: Care & Support for HIV+ Women, Infants, & Families. Strengthen linkage to HIV/AIDS care & support & MNCH services for the lactating women, their infants & families: linkages to PNC, EPI & ART clinics, redefine the PNC package with a view of integrating PNC package into EPI, Job Aids & SOPs.

Uganda has adopted Option B+ for all HIV positive pregnant women, hence the following PMTCT services will be offered in order to achieve this: Training of HCWs to provide Option B+ as opposed to previous Options A &B; Follow up of these women to ensure adherence; Partner involvement; Ensuring Facility delivery ; Lab monitoring & Post natal services including Infant feeding issue

In FY 2012, the project will continue improving the capacity and conditions of 8 KCCA health facilities (Kitebi HCIII, Kawaala HCIII, Komamboga HCIII, Kawempe HCIV, Kiruddu HCIII, Kisenyi HCIII, Kiswa HCIII and Kisugu HC III) to provide comprehensive HIV/AIDS care and treatment.

A total of 25,000 adult active clients are targeted for a comprehensive package of high quality care and treatment services of counseling for clients and family members; provision of antiretroviral therapy (ART); screening and treating opportunistic infections; screening and treating sexually transmitted infections (STIs); providing vital information on cotrimoxazole prophylaxis, safe water, nutrition, STI, FP, enrolling clients on cotrimoxazole prophylaxis; providing safe water vessels and promoting safe water use; providing condoms to sexually active clients. Of these, 14,000 adults will be active on ART. The program will continue to support patient ART adherence at all supported facilities to >95% in 90% of patients. Patients will continue to have biannual CD4 tests for both ART and pre-ART clients to monitor response to therapy and support timely ART initiation respectively.

The project will support the health facilities to scale up treatment services so as to improve the quality of life of PLHIV while emphasizing the sustainability of these services within the government structure. The initiation and scale-up of quality comprehensive HIV/AIDS services in the KCCA facilities is intended to contribute towards the national prevention and control of STIs/HIV/AIDS strategies and key interventions as stipulated in the HSSP III (2010/11- 2014/15) and specifically to the national indicator of The proportion of people who are on ARVs increased from 53% in 2009 to 75% by 2015 among adults and from 10% to 50% in children less that 15 years of age

In FY 2012, IDI will support KCCA facilities (Kawempe, Kiruddu, Kiswa, Kawaala, Kitebi, Kisenyi, Kisugu and Komamboga) to provide pediatric HIV care and treatment services. 2500 pediatric individuals will receive at least a minimum of one clinical service. Of these, 1650 children and adolescents are expected to receive ART.

Pediatric clients will be facilitated to access a comprehensive package of high quality care and treatment services. These services will include; early infant diagnosis of HIV; development and growth monitoring; immunizations according to the recommended national schedule; prophylaxis against opportunistic infections; treatment of acute infections and other HIV-related conditions; education and counseling of the caretakers on optimal infant feeding, personal and food hygiene, disease staging; ART where indicated, psychosocial support for the infected child, caregiver & family; and referral of the infected child for specialized care if indicated; and community-based support programs.

HCWs will be trained in pediatric care and treatment as well as specialized pediatric counseling. This will enhance their knowledge, skill and attitudes in the management of children. Continuous mentorship and support supervision will be done at the health facilities. Continuous Medical Education (CMEs) focusing on managing special pediatric issues will be promoted at all the supported health facilities. The CMEs will involve clinical case reviews, assessments and use of guideline and ART regimen decisions.

Strategies employed and the achievements through Pediatric care and treatment services contribute to the the national prevention and control of STIs/HIV/AIDS strategies and key interventions as stipulated in the HSSP III (2010/11- 2014/15) specifically to the national indicator of The proportion of people who are on ARVs increased from 53% in 2009 to 75% by 2015 among adults and from 10% to 50% in children less that 15 years of age.