Mildmay Uganda (MUg) supports the implementation of comprehensive HIV/AIDS services in the central region districts of Uganda. The overall goal of this project is to support the Government of Uganda to provide and scale-up comprehensive HIV/AIDS care, treatment and prevention services through the integration and strengthening of the District Health Service (DHS) between 2010 and 2015. Key objectives are: To increase access to family-centered, comprehensive HIV and AIDS prevention, care and treatment; Build human resource capacity for sustainable delivery of HIV and AIDS services; and Strengthen DHS planning, administration, M&E, logistics and supply chain management mechanisms. In FY 2011, MUg maintained 43588 clients in care (59% on ART), and offered technical support to 183 HCs in 18 districts.

In FY 2012, MUg will continue to provide technical support in 16 districts in the Central Region (Buikwe, Nakaseke, Mityana, Mubende, Nakasongola, Luwero, Mpigi, Gomba, Butambala, Masaka, Kalungu, Bukomansimbi, Lwengo, Lyantonde, Sembabule, and Wakiso). The program plans to reach 76,500 clients with PITC; maintain 48,500 clients and enroll 10,000 clients in care, maintain 25,757 clients and enroll 5,000 on HAART, 55,000 clients on CTX prophylaxis and 44,000 clients screened for TB, and 2,750 OVC and their families. Programming will centre on district priorities, national policies, sustainability and exit planning by districts, effective utilization of information for M&E, bi-annual project evaluation and involvement of MoH. MUg will build capacity for district administrative and health workers for HIV service delivery, leadership and governance, HMIS, HRM, M&E, logistics, finance, and laboratory and scale up EID. No plans to purchase vehicles with FY2012 funds.

Adult care and support services comprise facility-based and home/community-based activities for HIV-infected adults aimed at extending and optimizing quality of life from the time of diagnosis throughout the continuum of illness, through provision of clinical, psychological, social, spiritual, and prevention services; and for improving the lives of their contacts (HIV-affected persons). Services include, HCT, treatment and prevention of Opportunistic Infections (OIs) including TB, management of common infections, pain management, functional rehabilitation, nutrition and food security intervention, mental health, eye care, dental, sexual and reproductive health services, breast and cervical cancer screening. MUg currently has 45,588 clients in care. To scale up access to adult care and support, MUg will maintain 41,250 clients and enroll 13,412(80% adults) new clients. Mildmay Uganda will support 55,000 HIV-positive individuals with CTX prophylaxis adherence monitoring. Laboratory tests will include 60,000 FBC, 60,000 CD4, 3000 syphilis, 900 malaria, 700 pregnancy tests, 14,000 LFT and RFT. Procurement and distribution of safe water systems, cotrimoxazole for prophylaxis, malaria prevention, Condom distribution, family planning information and commodities for adolescents. Positive Health Dignity and Prevention (PHDP) activities for improving HIV care and HIV prevention include partner testing, counseling, OI management, palliative care needs and pain management, STI management and condom distribution, nutritional information, care and support, alcohol abuse and drug adherence. Purchase Non-ARVs medicines for adults at COE and a buffer for district health facilities towards improving the quality of care for HIV+ clients. Integration of HIV care into other health services will include cervical and breast cancer screening, PMTCT, mental health, Integrated Management of Acute Malnutrition, waste management, Sexual and Reproductive Health: (family planning, treatment of STIs, adolescent sexual and reproductive health), maternal and child health (MCH). MUg will partner with PACE through the DHS to provide basic care kits to all eligible clients. MUg will continue to support the use of the National HMIS data management systems and other National guidelines and policies. To avoid duplication, MUg will collaborate with other partners supporting PMTCT, sexual and reproductive health, and door-to-door HCT in the districts and in PMTCT/EID, care and support linkages. Human resource capacity will be built through; the pre-existing meetings such as CMEs in the districts for sensitizations, in-service trainings in partnership with Baylor Uganda information dissemination to address identified gaps in the health systems; tailor-made skills-building for district key staff) in leadership, governance, budgeting, resource mobilization, monitoring and supervision of health services and HRM to enhance capacity for managing health systems; Task shifting models promoted like nurse led clinic to mange stable HIV patients; Village Health Teams (VHT)/PHA networks offered technical support to link clients to HC, carry out continuous community awareness, mobilization and support community-based adherence systems for TB and ART and systems strengthened for M&E, HMIS, forecasting, quantification and procurement of logistics and EMHS. HC will be supported to accurately forecast, submit timely drug and supplies requisitions regularly to MoH.

Mildmay Uganda (MUg) is currently offering technical assistance to develop the capacity of the District Health Services in 16 districts of the Central Region of Uganda to effectively deliver sustainable health services and scale up access to quality HIV and AIDS care and support, including OVC. There are 2.43 million orphans in Uganda, 8 million of whom are critically or moderately vulnerable (NSPPI II) and only 11% of the these have been reached with OVC services (Situational analysis report, 2010). The MUg OVC program therefore aims to improve the quality of life of OVC and their households through provision of a comprehensive care package and its priority areas include the improvement of the livelihoods of the OVC, the development and strengthening of partnerships, linkages and referral systems between OVC service providers, and OVC service provider capacity. Its primary target population is the HIV positive child, their care giver, siblings and other OVC categories in the community as identified by the VHT and local CBOs. MUg currently provides HIV care to 3754 children (17% of patients in care) aged 0-17 years. In FY2011, MUg provided services in 7 Core Program Areas (CPA): socio-economic security 75; food security and nutrition 150; care and support 412 education 187; health 3754; child protection 37; and capacity building to 938 care givers as of June 2011, in addition to psychosocial support received. MUg offered technical assistance to DHS; mapping out OVC service providers, introduced the OVC Cir cle Model to 15 districts, trained CDO on OVC data collection tools for mapping service providers and OVC families, followed up children benefiting from more than three services and supported Districts to develop work plans for 2012. In FY 2012, through using the Circle model, MUg will reach 2,750 OVC and their families with at least three 3 OVC CPAs beyond psychosocial support. It will support DHT to functionalize existing OVC structures, strengthen linkages and networks with other public and private sector OVC service providers and with other implementing partners to increase OVC services and to strengthen the existing referral systems. MUg will continue to provide direct OVC service in 9 CPA; Socioeconomic security, food security and nutrition, care and support, education, health, child protection, psychosocial support, legal support and capacity building. MUg will promote and support the integration of OVC programs into other health services which include PMTCT, mental health, Integrated Management of Acute Malnutrition, Adolescent Sexual and Reproductive Health and maternal and child health (MCH). The major challenge has been the achievement of a minimum of the 3 CPAs for the OVC but efforts are being made to create linkages and referrals through the circle of providers. Other challenges faced include low prioritization of the OVC service in all districts, limited resources, inadequate OVC structures in some districts, and inadequate functional linkages. The program is in line with the NSPPI and it will train the DHS in OVC service provision, enhance the formation of circle of service providers in each sub county, provide sub grants to districts and CBOs to enable scale up OVC services. Human resource DHT capacity for sustainable OVC service delivery and its M&E using the MGLSD OVC tools will be built starting with the DOVCC team.

Mildmay Uganda is currently offering technical assistance to develop the capacity of the District Health Services in 16 districts of the Central Region to provide comprehensive care and treatment services including TB/HIV. In FY2011 Mildmay Uganda main site ensured: 100% TB screening, all pre-ART and ART patients diagnosed with TB received treatment, access to cotrimoxazole prophylaxis and ART. In the districts, TB case finding, completion or cure rates, access to cotrimoxazole and ART are all still below national targets. In FY 2012, Mildmay Uganda will support districts to achieve 100% access to TB screening, cotrimoxazole prophylaxis and improving TB completion or cure rates and capacity building to improve performance on TB/HIV indicators in line with the National TB guidelines. Provision of Isoniazid Prophylaxis Therapy in HIV care and treatment settings will commence in FY2012. 1600 HIV -positive incident TB cases (on ART and pre-ART) will receive treatment for TB, and have their HIV test results recorded in the TB register. 11760 TB (smears) tests will be done for TB suspects at the main site. The following infection control measures will be integrated in the DHS: Isolation of coughing patients and giving them priority in the clinic to reduce long waiting hours; provision of personal protective gear to patients to reduce air contamination from coughing patients; good infrastructural designs of the patient waiting areas and consultation rooms which aid in ensuring good natural air circulation and ventilation. For intensified case finding, early screening and diagnosis of TB amongst all clients at HCT, clinic visits and home visits (for contact tracing amongst household members of index TB patients); and early initiation of treatment for those diagnosed with TB will be conducted. Mildmay Uganda will promote and support the integration of TB into other health services as well as collaborate with other partners supporting PMTCT, sexual and reproductive health, and door-to-door HCT. Promoting functioning of the national HMIS management systems and adherence to national guidelines and policies on TB and HIV will be part of the continuous technical assistance and supervision as well as evaluation of the HC in the districts. Mildmay will continue to participate in NTLP forums and report using both MOH and USG M&E indicators. Mildmay Uganda will support the District TB and Leprosy supervisors (DTLSs) activities, CMEs will be arranged in the districts to build capacity of the health workers using the standard MOH-NTLP training tools in TB/HIV co-management.Tailor-made skills-building will be done for district and HC III & IV key staff, in leadership, governance and HRM to enhance capacity for managing health systems and promote Task shifting models. Village Health Teams (VHT)/PHA networks will be offered technical support to link TB suspects to HC, to carry out continuous community awareness and mobilization for health care services, support community-based adherence systems for TB (CB DOTS) and ART. Mildmay will join the DHT for mentorship in planning, budgeting, resource mobilization, monitoring and supervision of health services. HC will be supported to accurately forecast, submit timely TB drug and supplies requisitions regularly to MoH procurement system and maintain local buffer stock. An evaluation of the new WHO TB diagnostic algorithm will be conducted.

Nationally an estimated 1,192,372 (13% children) are PLHIV (MOH-Epidemiological Surveillance Report, 2010). Mildmay Uganda has 22,088 clients at the Centre of Excellence (COE) of which 17% are children while district based supported programs have 23,500 clients with 13% being children in HIV care. In FY 2012, Mildmay Uganda will maintain 48,500 clients and enroll 10,000 in care. Through support to the DHS, Mildmay Uganda will; Support Community structures village health teams (VHT), PHA networks and OVC linkages to strengthen and offer technical support to link children and their families to health facilities; support community awareness and mobilization for childrens care services and support establishment of task-shifting models like peer-to-peer education; 320 HCs will be targeted for provision of PWP services including youth friendly SRH services for adolescents including ongoing counseling, STI management and condom use, OI management, palliative care and pain management nutritional care and support; support 200 eligible HIV-positive malnourished children with therapeutic/supplementary food and 4,050 will receive food and/or food security services at the COE; 8,804 HIV-positive children provided with Cotrimoxazole prophylaxis and monitored for adherence. Mildmay Uganda will perform 600 DNA PCR tests and act as a backup for the National EID lab, the national EID programme estimates 65,000 infants tested. Mildmay will support districts to strengthen EID sample collection, result delivery and linking the mother-baby pair to care and treatment; 200 infants born to HIV-Positive women will be started on CTX prophylaxis within two months of birth at Mildmay. Mildmay does not have maternity and postnatal services and therefore relies on external facilities referring new born babies to be registered into care. Mildmay Uganda will provide technical and logistical support to health facilities to integrate effective pediatric HIV services into other health services. Through OVC linkages circle model in the districts, care and support services will be integrated and scaled up. To avoid duplication, Mildmay Uganda will collaborate with other partners supporting PMTCT, SRH and door-to-door HCT (ICOBI). Adolescent care and transition into adult care through support groups, adherence support, how to handle adolescent and adulthood. Engage adult care takers into the transition process while integrating with reproductive health activities. Mildmay Uganda will provide technical assistance to districts promoting alignment and adherence to national policies and guidelines. Mildmay Uganda will support partnership meetings at national, regional, district and clinic site meetings for program improvement in pediatric HIV prevention, care and treatment. These meetings will facilitate the leadership role of focal persons, create a forum for inter-facility experiential learning and provide opportunities to jointly address paediatric HIV Care challenges, while enhancing accountability. Mildmay will support districts to implement, VHT and CBO M&E systems which include pediatric indicators. Systems will be strengthened in HMIS for reporting, forecasting, quantification and procurement of logistics and EMHS. DHO, district HMIS focal persons, procurement personnel and HSD in-charges, will be targeted for hands-on training. The DHT will be supported in planning, budgeting, resource mobilization, monitoring and supervision of paediatric Care services.

In FY2011, Mildmay Uganda offered technical support to develop the laboratory capacity of the District Health Services in 18 districts of the Central Region of Uganda. Findings from the HC capacity assessments done by Mildmay Uganda indicated that out of the 183 HC only 92 had laboratories of which 84 were functional. In FY 2011 Mildmay Uganda strengthened inter-facility and inter-district linkages to the Mildmay Uganda laboratory for HIV disease diagnosis and monitoring and offered technical support and quality assurance. Mildmay Uganda has supported the national EID project in setting up 3 regional hubs in the central region including Masaka, Mubende and Kampala (CPHL). Each of these hubs has the capacity to support 20-30 HC.

In FY 2012 Mildmay Uganda will provide technical support to the above districts except Mukono and Buikwe targeting 54 testing facilities to be able to perform clinical laboratory tests through appropriate training, coaching, mentoring, and support supervision to DHS to strengthen laboratory supply chain systems management. Mildmay Uganda will work to identify other stakeholders to partner with in this effort. Mildmay Uganda will support Districts to make functional national HMIS and other national guidelines and policies for laboratory systems. Support the National EID program lab at CPHL to perform 65,000DNA PCR tests will continue. Mildmay Uganda will support the national HMIS data management systems and other national guidelines and policies for laboratory systems. Program activities will be guided by the relevant national protocols and guidelines and will be implemented in joint consultation with the district and MoH. Alignment and adherence to these policies and guidelines will be part of the continuous technical support and supervision as well as evaluation of the HC in the districts. Mildmay Uganda will strengthen human resource capacity for sustainable laboratory services in the 16 districts through in-service training, placements, mentoring and coaching to enhance capacity for managing testing facilities. In FY 2012, Mildmay will support CPHL to coordinate and strengthen management of laboratory services in Uganda. Specific activities for CPHL will include development of guidelines and policies for quality assurance, infrastructure development, logistics and equipment management, Training of Trainers, improvement of laboratory information management and support supervision. Laboratory services will be strengthened using the WHO laboratory management towards accreditation approach and implementation of quality management systems starting with the lab at Mildmay COE in the first year.

Mildmay Uganda offers technical support to develop the capacity of the District Health Services in 16 districts of the Central Region of Uganda (Wakiso, Luwero, Nakaseke, Nakasongola, Mityana, Mubende, Mpigi, Masaka, Lyantonde, Ssembabule, Bukomansimbi, Lwengo, Kalungu, Buikwe, Butambala, and Gomba) to effectively deliver sustainable health services and scale up access to quality HIV/AIDS care and support. There are 505 health facilities in the region and Mildmay Uganda has been able to provide technical support to 183 (comprising of district hospitals, HC IV, HC III and HC II) HC in areas of service delivery, strategic information, health workforce, health finance through sub granting to the districts, medical products and technology, and leadership and governance. In FY2011 Mildmay Uganda offered technical support in the areas of laboratory, Sexual and Reproductive Health, OVC, Waste Management, HMIS, TB, Human Resources, and Leadership and Governance, HIV care and treatment and provided direct service to 25 HC through buffer for ARVs and Cotrimoxazole worth US$214,592. Mildmay Uganda sub granted a total of US$ 245,454 to the 18 districts. Mildmay Uganda held 30 pre-implementation and 43 forward meetings with the districts and other stakeholders to improve planning and coordination of project interventions. In FY 2012 Mildmay Uganda will continue to offer technical support to 16 districts following the rationalization process ending September 2011 with handover of two districts - Mukono, and Buvuma. In a phased approach the technical support will be scaled up to reach an additional 161 HC. Mildmay Uganda will promote and support the integration of HSS into other health services which include cervical and breast cancer screening, PMTCT, mental health, Integrated Management of Acute Malnutrition, waste management, Sexual and Reproductive Health: (family planning, treatment of STI, adolescent sexual and reproductive health), maternal and child health (MCH). Mildmay Uganda will support Districts to make functional the national HMIS data management systems and other national guidelines and policies for laboratory systems. Program activities will be guided by the relevant national protocols and guidelines and will be implemented in joint consultation with the district and MoH. Alignment and adherence to these policies and guidelines will be part of the continuous technical support and supervision as well as evaluation of the HC in the districts. Through existing district partnerships Mildmay Uganda will continue to provide technical support to 320 HC (88 ART facilities) with PITC, SRH, OVC services, health care waste management, and linking communities to these facilities through VHTs. Laboratory support will be provided to 54 facilities. To improve on strategic information flow, technical support will be provided to strengthen M&E, use of HMIS for reporting (including feedback), forecasting, quantification and procurement of logistics and EMHS. Mildmay Uganda has developed customized tools for monitoring health system strengthening activities e.g. sub grant guidelines. Mildmay Uganda is supporting the districts to assess gaps in service delivery, to plan and secure funding to address the needs e.g. improving drug storage and laboratory facilities, sample transportation and training human resources for health.

According to the Epidemiological surveillance report (MoH, 2010), the HIV prevalence rate in central region is estimated at 7.5% and according to the MEEPP report (April 2009), only 15% of Ugandas population has been reached with HCT and only 20% have tested and know their HIV status. MUg HCT services will target family members of clients in Care and treatment, in patients and outpatients living in the Central region of Uganda. In FY 2011, MUg offered HCT to 57,372 individuals (5,606 at main site; 43,909 in the districts) as at June 2011 and it provided technical support to strengthen HTC services in 16 districts. MUg carried out special events of testing children in institutions and it carried out HBHCT targeting household members of TB patients. MUg carried out DNA-PCR and supported all its sites for early infant diagnosis (EID). Currently an average of 25000 HIV antibody tests and 1080 DNA-PCR tests are done annually. In FY 2012 MUg will reach at least 76,500 individuals with HCT (42,100 females and 34,400 males), 36,000 of who will be family members. 80% of all clients attending OPD will receive HCT. To ensure gender equity, MUg will integrate gender mainstreaming in HCT programming at its main site and in the districts with particular emphasis to male involvement and following up the index clients care giver, partners, children and other members of their families to access HCT. MUg will link the HC to regional EID hubs and then to CPHL to benefit from DNA PCR services for at least 80% of HIV exposed infants. All clients that test positive will be enrolled for care and support. Mug will continue to provide HCT services through outreaches, EID, PITC and to families of both inpatients and outpatients. All clients that test positive will be enrolled for care and support and those who test negative will be linked to other service providers for HIV prevention interventions. MUg will promote the integration of HCT into other health services and it will collaborate with other partners supporting PMTCT, SRH, and door-to-door HCT in the 16 districts. All HCT services will be delivered using the National HCT guidelines and MUg will provide support supervision to the HC within the districts for quality assurance and capacity development. MUg will strengthen the existing district structures to ensure successful referrals and linkages, particularly through the VHTs, CBOs. MUg will promote couple counselling, family support counselling, adolescent meetings, peer-to-peer trainings and a family centred approach to scale up HCT and the DHT will be equipped with skills to provide and follow up on HCT services. MUg will build human resource capacity for sustainable delivery of HCT services using the pre-existing meetings such as CME to ensure continuity and to address identified gaps. All HC will be supported to implement a functional task shifting model. Districts will be strengthened for M&E of HCT services and the data will be disaggregated according to couples, pregnant women, age and gender. MUg will continue to support the districts to strengthen the existing strategies for RCT, VCT and HBCT through; HC Capacity Assessments to deliver quality HCT services; Mentoring and coaching health workers in the HC to offer PITC and it will work with the districts to set up inter-facility/inter-district EID sample collection & results disbursement networks, linking HC to the regional EID hubs and finally to the National EID laboratory (CPHL).

Mildmay Uganda (MUg) is offering technical assistance to develop the capacity of the District Health Services in 16 districts in delivery of comprehensive HIV and AIDS care and treatment services in collaboration with other Partners who support complementary HIV and AIDS services including Community, HCT, PMTCT, Safe male circumcision. According to the PEPFAR report of April 2009, an estimated 250, 000 PLHIV are in the Central region. Mildmay Uganda is currently offering direct service to 22000 active PLHIV receiving comprehensive HIV care and support at the main site and supporting 25,000 in the DHS. Women of the child bearing age (15-49) constitute 43% of those active in care. MUg offers both long term and short term family planning services, last year, 360 (7.5%) women of child bearing age received hormonal FP methods as part of the SRH intervention at the main site. This project targets HIV positive women within reproductive age group and their partners. In FY 2012 Mildmay Uganda will maintain 48,500 in care and enrol 10,000 new clients. Mug will scale up PMTCT prong 2 to offer family planning services, strengthen linkages for PMTCT service through inter-facility/inter district EID, CD4 samples collection and result disbursement networks, linking the HC to regional EID hubs and provision of efficacious PMTCT ARVs to both pregnant women and the infants. The scale up will be both at the main site and the districts. Monitoring and evaluation targets will be; 8800 HIV positive women counselled and provided with family planning methods, 288 eligible HIV infected pregnant women received HAART; 288 HIV infected pregnant women started on co-trimoxazole prophylaxis; Support 100 HC providing ANC services that provide HIV testing and ARVs for PMTCT on site and linkage of these HC for EID and CD4 sample transfers. Mildmay Uganda will target; 200 exposed infants received first HIV test result within 2 months of age, 200 exposed infants started on co-trimoxazole prophylaxis, MUg does not offer ANC services but offers HAART for pregnant mothers and infants in its care and will document number of HIV pregnant women and their infants receiving HAART on site. Mildmay Uganda will promote and support the integration of FP services into other health services which include ART, mental health, Integrated Management of Acute Malnutrition, waste management and to avoid duplication Mildmay Uganda will collaborate with other partners supporting PMTCT, sexual and reproductive health, and door-to-door HCT in the 16 districts. Alignment and adherence to these policies and guidelines in FP guidelines, data management systems and other national guidelines and policies on MNCH, PMTCT, EID, HCT, and strengthen logistic and supplies of FP commodities in the districts through NMS and JMS.will be part of the continuous technical assistance and supervision as well as evaluation of FP in the districts. Mildmay Uganda will build human resource capacity for sustainable delivery of FP services in the 16 districts through mentoring and coaching and collaborate with other IPs to conduct in-servicing training. Mildmay will use community structures in the districts for sensitizations, information dissemination to address identified gaps in the health systems for PMTCT. Health systems will be strengthened for M&E, use of HMIS for reporting (including feedback), forecasting, quantification and procurement of logistics and EMHS for Family planning drugs

The ART services will target eligible adult patients in the 16 Districts of Central Region according to national treatment guidelines. Technical support supervision will be offered to the District Management Teams and at health facility level. A monitoring and evaluation frame work in line with PEPFAR and MOH ART indicators will be used to track and evaluate Mildmay and DHS clinical outcomes. At the Mildmay centre of excellence; an average of 350 adults are newly enrolled on ART every quarter. Ninety eight percent of both adults and children on ART are known to be alive 12 months after initiation of ART. Tracking of clinical outcomes is done through routine reviews at the facility using a number of clinical parameters including weight CD4 and occurrence of Opportunistic Infections are assessed according to national and international guidelines. Performance data is used routinely to improve indicators and program practices. ART retention and adherence is supported through the adherence support team at Mildmay and community structures- CBVs and VHTs. An adherence rate of 80% has been observed at the main site (CoE). The ART enrolment target is 7500 (85% will be adults). Lab tests at Mildmay; 60,000 FBC, 60,000 CD4, 4000 viral load tests and 14,000 LFT and RFT to be done.

Mildmay Uganda supports the integration of adult ART services into other health services which include cervical and breast cancer screening, PMTCT, mental health, Integrated Management of Acute Malnutrition, waste management, Sexual and Reproductive Health: (family planning, treatment of STI, adolescent sexual and reproductive health), maternal and child health (MCH). To avoid duplication, Mildmay Uganda collaborates with other partners supporting PMTCT, sexual and reproductive health, and door-to-door HCT in the 16 districts.

Mildmay Uganda supports functioning of the national HMIS data management systems and adherence to national guidelines and policies ART, PMTCT, counseling and waste management. Programmatic efficiency strategies including sub-granting for district led activities, support for task shifting models, functioning of community based structures (VHTs, CBVs),strengthening of reporting systems through HMIS, audit, leadership and governance to allow for expansion and comprehensive HIV programming. Mildmay Uganda has a sustainability plan in place; the districts are being supported by Mildmay Uganda to develop sustainability plans for comprehensive HIV services. Mildmay Uganda will promote and support the integration of adult ART into other health services for sustainability of ART service delivery. In addition Mildmay will work with other district partners and MOH in ART service delivery. Systems will be strengthened for M&E, use of HMIS for reporting (including feedback), forecasting, quantification and procurement of logistics and EMHS. DHO, district HMIS focal persons, procurement personnel and HSD in-charges, will be targeted for hands-on training. Mildmay will join the DHT for mentorship in planning, budgeting, resource mobilization, monitoring and supervision of health services. HC will be supported to accurately forecast, submit timely ARV drugs and supplies requisitions regularly to MoH procurement system.

Mildmay Uganda will maintain 12557 clients (17% children) on ART and support the DHS to maintain 13200 (13% children) on to ART. To scale up access to pediatric ART in the central region, Mildmay Uganda will enroll 7500 (15% children) new ART clients in the central region. Mildmay will support the DHS with MOH SOPs and guidelines, technical support to 320 HC on scaling up of pediatric ART treatment, support functionality of the CMEs at HSD level, and through sub-grants to support linkages of children to care. Mildmay Uganda will support CD4 test availability for children in pre-ART or on ART through sub-grants to the districts for timely samples transfer to the other district labs with CD4 capacity. Mildmay aims to do 60,000 CD4 tests and 4,000 viral load tests which will include tests for children. Mildmay Uganda will promote and support the integration of pediatric ART into sexual reproductive health, OVC care, general outpatient, maternal and child and other health services. To avoid duplication, Mildmay Uganda will collaborate with other partners supporting PMTCT, sexual and reproductive health, and door-to-door HCT, nutrition providers in the districts. Mildmay Uganda will support the national HMIS data management systems and dissemination of national treatment guidelines and policies on pediatric ART, TB, PMTCT, EID, counseling, alignment and adherence to these policies and guidelines will be part of the continuous technical assistance and supervision as well as evaluation of the HC in the districts. Mildmay will report using both MOH and USG M&E indicators. Mildmay Uganda will support partnership meetings at national, regional, district and clinic site meetings for program improvement in pediatric ART practices. These meetings will facilitate the leadership role of focal persons, create a forum for inter-facility experiential learning and provide opportunities to jointly address ART challenges, while enhancing accountability. Systems will be strengthened for M&E and use of HMIS for reporting (including feedback), forecasting, quantification and procurement of logistics and EMHS. DHO, district HMIS focal persons, procurement personnel and HSD in-charges, will be targeted for hands-on training. Mildmay will support the DHT in planning, budgeting, resource mobilization, monitoring and supervision of paediatric ART services. Mildmay will mentor/coach district health workers depending on the gaps identified in their ART knowledge and skills.