Reach Out Mbuya Parish HIV/AIDS Initiative (ROM) is a community faith based Non-Governmental organization that operates in Kampala and Luwero districts with four sites in addition to outreach activities. The target population of approximately 98,000 people is characterized by high poverty levels and HIV prevalence of 9%.

ROMs goal is to contribute to universal access to treatment, care, prevention and support in the communities served through provision of comprehensive community based services. They have documented excellent program outcomes to date including TB completion rates above WHO recommended rate of 75%, MTCT of 0% and average treatment adherence of 85% for more than 80% of the patients served. Aspects of the model of service delivery that may contribute to the excellent outcomes include the comprehensive approach, family and community involvement, involvement of people living with HIV, use of satellite clinics as a strategy for decentralizing care to the community, task shifting and delivery of services within a defined catchment area which facilitates home visits and referrals between the community and facility.

Planned activities in FY 2012 include; scaling up prevention services and specifically targeting MARPS, increasing access to quality HIV/AIDS care, support, treatment, and TB/HIV services, maintaining MTCT at 0%, strengthening laboratory capacity to support care and treatment services, provision of OVC services and strengthening of health systems for delivery of quality HIV services. They are well positioned to offer MARPs services because of their location in the middle of a very urban poor slum community and the rapport and relationships they have established in this community.

PEPFAR will support the Government of Uganda to expand access to HIV care and support to achieve universal access by 2015. ROM will support the scale-up of care and support services through its comprehensive community-based HIV/AIDS services and capacity building

In FY 2013, the program will support the provision of clinical care services for at least 3,420 adults as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals receiving care and support services. Specific attention will be given to key populations such as truck drivers, fishermen, commercial sex workers and men who have sex with men. 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. ROM will be expected to implement approaches to promote an effective CoR model and monitor key indicators along the continuum.

The program will be implemented in four parishes in two districts of Uganda. ROM 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; implementation of quality improvement activities for adherence and retention, pain and symptom management, and providing support through targeted community outreaches in high prevalence, hard to reach and underserved areas.

Focus will be placed on increasing access to CD4 testing among pre-ART clients for ART initiation in line with MoH guidelines. This has been a major challenge for treatment scale up nationally. Working with the Central Public Health Laboratory and other stakeholders, national CD4 coverage will be improved from the current 60% to 100% over the next 12 months. This program will support sample referral network in line with the national CD4 expansion plan; and will monitor and report clients access to CD4 testing quarterly. In addition, ROM will need to regularly keep track and report on any client waiting lists.

ROM will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. They will coordinate with the National Medical Stores and Medical Access Uganda Limited for HIV commodities including cotrimoxazole and laboratory reagents. The program will build the capacity of facility staff to accurately report, quantify and order commodities in a timely manner.

ROM will work with other USG partners such as SPRING, MOH/HEALTHQual, ASSIST and 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 will be critical.

The program is aligned to the National Strategic Plan for HIV/AIDS (2011/12-2014/15); and will support and contribute to the national M&E systems as well as work within district health plans. ROM will work under the guidance of MOH/ACP and the Quality Assurance Department for training, mentorship, support supervision and quality improvement.

In FY 2013, ROM will reach 2,000 OVC within its catchment area. ROM will provide support to 2,000 OVC in priority program areas as determined by the National Strategic Program Plan Interventions for Orphans and Vulnerable Children (NSSPI) and the vulnerability index tool. The core program interventions include: health, education support, psychosocial support, legal support, shelter, economic strengthening and food and nutrition. Education support for OVC (Tuition/fees, scholastic materials, foot wear and uniforms, school monitoring and alternative non-formal education for children not in school) will continue to be strengthened for children in emergency situation. Psychosocial support (life skills training, peer to peer support, community-based child friendly recreational activities, emotional, social, mental and spiritual support, all of which are considered essential elements in the development of a child) will be provided to OVC to ensure that childrens emotionally related issues are handled.

ROM will continue working to ensure children (OVC) in care are provided with a safe and structured environment (identify and refer child abuse cases) through the play therapy carried out every clinic day.

ROM will hold friends forums for HIV positive children once every month to understand them better as well as identifying the challenges they face. Parents forums will be held to play roles in taking good care of their children and also discuss challenges faced.

ROM will integrate other OVC core service areas within the prevention, medical and existing community structures including: Health (Palliative care, home-based care, preventive and curative care and training in pediatric HIV care); Food and nutrition (Food assistance) with emphasis on sustainable food security; Shelter (Grants in form of house rent will be given to households in absolute need); Livelihoods and economic empowerment of OVC households (facilitate acquisition of skills, support access to vocational training and micro finance).

ROM strengthened follow up through integration of OVC activities into the community network of care to better follow them up and vice versa, home and school visits have been improved and prevention activities have been integrated into the Saturday childrens club and facility based activities.

ROM will follow the (NSPPI) guidelines, and will partner with Ministry of Gender, Labor and Social Development through the National Council for Children and the Uganda Child Rights NGO Network (UCRNN) to ensure protection of children. Children will be referred to existing legal support structures like the Family Protection Unit of Uganda Police and other existing UGANET, Uganda human rights commission and foundation for human rights initiative. There is a draft legal support policy which will guide legal protection activities within ROM. The organization will continue strengthening its internal system through in service trainings, refresher course, mentoring, and exchange visits. A total of 20 staff will be trained, mentored and coached on how to manage HIV clients.

ROM will also undertake M&E activities to assess interventions that work best and those that need strengthening.

The ROM program will focus on supporting and contributing to the MOH to scale up TB/HIV integration; and specifically meet the PEPFAR goal to achieve TB screening of 90% (731,690) of HIV positive clients in care, and 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. The program implemented by ROM will contribute to this target by screening at least 3,382 HIV positive clients for TB; and starting 113 diagnosed individuals on TB treatment. The program will support TB/HIV services in four parishes in two districts in the country.

ROM will improve Intensified Case Finding (ICF) and 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- GeneXpert and fluorescent microscopy. ROM will support MDR-TB surveillance through sputum sample transportation to GeneXpert hubs and receipt of results at facilities.

In FY 2013, the program will ensure early initiation of all HIV positive TB patients on treatment through the use of linkage facilitators and/or the provision of treatment in TB clinics. ROM 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 and ensure adequate natural ventilation.

ROM will collaborate with the MOH/ACP and National TB and Leprosy Program (NTLP) who will be supported to roll out provision of isoniazid prophylaxis therapy, in line with the WHO recommendations.

In addition, ROM will work with USG partners such as SPRING, MOH/HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. The program will collaborate with other key stakeholders at all levels for provision of required wrap around services.

ROM activities 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 operate within district health plans. They will also work under the guidance of MOH/ACP, NTLP and the Quality Assurance Department to conduct trainings, TB/HIV mentorship, quality improvement and support supervision. Additionally, the program will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

Reach Out Mbuya Parish HIV/AIDS Initiative (ROM) will focus on supporting the Government of Uganda to expand pediatric HIV care and orphan and vulnerable children (OVC) support with the goal to achieve universal access to HIV care by 2015. Provision of comprehensive, community-based HIV/AIDS services and Capacity Building of Indigenous Organizations in the Republic Of Uganda program implemented by ROM in four parishes in two districts will provide clinical services to at least 338 children contributing to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services in FY 2013, including 73,169 children.

The program 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. Early Infant Diagnosis (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 for early enrolment of children in care. ROM will implement community mobilization and targeted activities such as Know Your Childs 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 guidelines.

ROM will support retention of adolescents in care using expert peers and adolescent support groups. They will be provided with positive health dignity and prevention services including, sexual/reproductive health services, psychosocial support and life skills training. Recommendations from the planned national adolescent service assessment will be incorporated into planned 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 receiving OVC services are screened for HIV and appropriately linked to care and support. The program will also support the integration of HIV services in routine pediatric health services, including the National Child Health Days.

ROM will liaise with PACE and UHMG for provision and distribution of basic care kits to clients, and with National Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities including cotrimoxazole and lab reagents. The program will build the capacity of facility staff to accurately report, quantify and order commodities in a timely manner.

ROM will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. ROM 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. ROM will work under the guidance of MoH/ACP and the Quality Assurance Department in pediatric trainings, national pediatric mentorship framework, quality improvement 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 the Early Infant Diagnosis (EID) 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 is aimed at all pre-ART targeted population receiving CD4 tests from the current 60% to 100%, improving the quality of laboratory services, reducing stock out of reagents , laboratory supplies and commodities, reducing equipment downtime and improving data collection, 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 trained lay health workers.

Based on this approach, ROM will specifically facilitate transportation of specimens for all clients to ensure timely linkage of clients who need ART and other HIV services for the four sites they support. They will also support salaries and training of laboratory staff. They will implement appropriate quality assurance activities based on the WHO Strengthening Laboratory Management Towards Accreditation (SLMTA) as the mainstay of lab quality improvement in addition to other quality assurance activities.

ROM 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 (PITC), client initiated counseling and testing, home based counseling and testing and use of mobile out reaches to provide counseling and testing services. ROM will contribute to the continuum of response by linking clients to other health services including HIV Care and Treatment, HIV prevention services such as Voluntary Medical Male Circumcision (VMMC) 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 unmet need. Partner and district-level capacity were also key factors in determining the allocation of program resources. This program is located in two districts of Kampala and Luwero and the target populations are the poor communities within these districts. ROM will specifically prioritize the following groups for HIV Testing and Counseling (HTC), the commercial sex workers and their clients, fisher folks, long distance truck drivers, men who have sex with men and uniformed forces. The program will deliver services using mobile teams to reach the hard to reach populations such as the long distance truck drivers, the fishing communities, taxi drivers and market vendors.

ROM will report on the HTC activities above through the CDC quarterly report, the SAPR and APR.

Currently, PEPFAR contributes more than half of the MoHs HTC targets. Recognizing the important role of GOU, HTC program activities will be conducted in partnership with district local governments under the stewardship of the MoH, recognizing that the scale-up of activities will require a medium-term commitment by the USG.

Additionally, in order to maximize program success, this program will work towards evidence gathering for the purpose of standardizing service delivery, and improve services.

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 WHOs HTC Quality Assurance/Quality Improvement guidelines.

Reach out will contribute to other prevention efforts to reduce the further spread of HIV infection by specifically targeting the most at risk population (MARPS) including sex workers and their partners, long distance truck drivers, men who have sex with men and fisher folks.

ROM will provide the following services for MARPS:

They will provide HCT to 9,000 MARPS through different models including, moonlight VCT, mobile outreach activities ensure that MARPS receive HIV Care and Treatment (HCT) every three months and link all MARPS that test HIV positive into care and subsequently treatment.

ROM will increase the number of MARPS receiving risk reduction interventions including STI screening and treatment to 9,000, they will integrate positive health dignity and prevention activities at all levels of service provision with emphasis on partner identification and testing, and offer sexual and gender based violence screening and response.

They will partner with the nearby public health facilities and specific private clinics, to whom they will refer clients for condoms and other family planning services. Additionally ROM will supply water based lubricants to MARPS to reduce the risk of abrasions and HIV transmission.

Biomedical interventions to MARPS including Voluntary Medical Male Circumcision (VMMC) and PMTCT will be scaled up. 2,600 HIV negative men will be referred to IDI for VMMC and ROM will follow them up to ensure that they received this service.

Demand creation for MARPs services will be achieved through

- Sensitization, using peers, organizations that are working with MARPS and leaders of MARPS.

- Mobilization campaigns for the fishing communities.

-working with VHTs, community focal persons and local councils to sensitize the communities.

ROM will use various models of service delivery to ensure that they reach the MARPS including mobile outreach activities, fixed outreach activities, MARPS friendly clinics and office encounters for those clients who opt to receive services in the office.

To ensure retention of the MARPS, ROM will use VMMC to send reminders to clients, use a peer-led follow-up model and community workers to follow up clients in the community.

In FY 2013, Reach Out Mbuya (ROM) will facilitate the implementation of PMTCT Option B+ activities in four PMTCT sites.

Key strategic pivots for PMTCT will focus on:

1) Improving access and utilization of eMTCT services in order to reach more HIV infected pregnant women as early as possible during pregnancy. To achieve this ROM will ensure provision of universal HIV Testing and Counseling (HTC) services during ANC, labor and delivery, and community mobilization.

2) Decentralizing Treatment and Option B+ through the accreditation of all PMTCT sites at hospital; Health center IV and health center III levels. Activities will include site assessments for accreditation; identification of training needs; procurement of equipment; printing M&E tools, job aides and Option B+ guidelines, training of service providers and sample referral system for CD4+ and Early Infant Diagnosis (EID). The transition of Option B+ in ROM sites will be done in accordance with MoH guidance.

ROM 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 (IYCF) counseling, EID, Family Planning (FP) counseling, couples HTC, supported disclosure and ARV refills. Village health teams will also be utilized to enhance follow-up, referral, birth registration and adherence support. Through this model, 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 500 partners of pregnant women will be tested within the MNCH setting.

3) Supporting intensive M&E of activities to inform Option B+ roll out through cohort tracking of mother-baby pairs and electronic data reporting. All sites will actively document services provided to the mother-baby pairs at both facility and community level. Each beneficiary will have a standard appointment schedule that will be aligned to the follow-up plan of each PMTCT site. 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.

4) Facilitating quarterly joint support supervision & mentorships at all PMTCT/ART sites involving MOH, AIDS Development partners, Districts, USG, and implementing partner staff in accordance with MOH guidance. Site level support will entail cohort reviews, adherence rates, retention rates, data management, availability of supplies, commodities and tools, and knowledge gaps.

5) Integrating voluntary and informed Family Planning services with PMTCT service: ROM will refer clients with Family planning needs to the nearby public health facilities as well to specific private clinics which they have partnered with to ensure that their clients are able to access family planning services.

ROM will provide HIV counseling and testing to 1,000 pregnant women in four service outlets during FY 2013. A total of 450 HIV positive pregnant women will be identified, of which 383 will be initiated on HAART for life and 68 will be provided with ARV prophylaxis; in addition, 436 will receive ARV prophylaxis and DNA/PCR test will be done for 436 of exposed babies.

Reach Out Mbuya Parish HIV/AIDS Initiative (ROM) will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to treatment from 57% to 80% by 2015. The ROM program will enroll at least 795 new clients and support not less than 2,812 adults and children on treatment by the APR 2013; contributing to the overall national and PEPFAR target of at least 190,804 new clients and 490,028 individuals currently on treatment.

These targets were 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. Targets are not fixed, 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. ROM will target key populations using innovative approaches including setting up specialized services; such as moonlight services. ROM will work in four parishes in two districts in Uganda.

The program will support the MoH roll out of Option B+ for virtual elimination of MTCT through the following activities: accreditation of at least one additional health facility, training, mentorship, and joint PMTCT/ART support supervision. ROM will also support ART/PMTCT integration at facility level piloting feasible service delivery models, such as same day integrated HIV clinics.

CoR 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. ROM will support family planning and cervical cancer screening integration at facility level through provision of the services or referrals.

The program will implement quality improvement initiatives for the ART framework including: early initiation of ART eligible clients; 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 and alert stickers will be supported.

Special focus will be placed on adherence and retention of women enrolled under Option B+.

Increasing access to CD4 for routine monitoring of ART clients in line with MoH guidelines is a priority. ROM will support the sample referral network in line with this national CD4 expansion plan; and will monitor and report clients access to CD4 in quarterly reports.

The program will liaise with PACE and UHMG for provision and distribution of basic care kits to clients; as well as, coordinate with National Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities. ROM will build the capacity of facility staff to accurately and timely report, quantify and order commodities. ROM 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/AIDS (2011/12-2014/15); support and strengthen the national M&E systems; and work within district health plans. ROM will work under the guidance of MOH/ACP and the Quality Assurance Department in trainings, quality improvement, ART/PMTCT mentorship and supportive supervision.

Reach Out Mbuya Parish HIV/AIDS Initiative (ROM) will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015 working in two districts in Uganda. The Provision of comprehensive, community-based HIV/AIDS services and Capacity Building program implemented by ROM will enroll at least 199 new HIV positive children and support 1,246 children on ART by APR 2013. This will contribute to the overall national and PEPFAR targets of at least 38,161 new clients and 63,704 children current on treatment.

In FY 2013, ROM will support the national program scale up pediatric treatment through strengthening the identification, follow up and treatment for all infants using Early Infant Diagnosis (EID) focal persons, peer mothers, mobile phone technology and flagging files with initiate ART immediately stickers. Facilities will be supported to strengthen test and treat for all HIV positive children under two years in line with the national treatment guidelines.

The program will support the early initiation, adherence and retention of adolescents on treatment using expert peers and adolescent support groups. They will be provided with positive health dignity and prevention services including: sexual/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 child beneficiaries of OVC services are screened for HIV and appropriately linked to treatment.

ROM will support the integration of HIV services in routine pediatric health services, including the National Child Health Days.

The program will liaise with PACE and UHMG for provision and distribution of basic care kits to clients, as well as, with National Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). ROM will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

The program will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. They will also 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. ROM will work under the guidance of MoH/ACP and the Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework, quality improvement and support supervision.