The Uganda Episcopal Conferences (UEC) AIDS, Care, and Treatment Program (ACT) will work with local sub partners, health care facilities, and national and local district government to strengthen the faith-based health systems in 15 Districts in Uganda by the end of FY 2013.

Supported Health facilities (HCFs) will include; Aber, St. Joseph, and St. Marys hospitals, Dr. Ambrossoli Memorial - Kalongo, Kamwokya Christian Caring Community, Nsambya, St. Francis Nyenga, Nkozi, Virika and Villa Maria Hospitals , Comboni Kyamuhuga, Kasanga Health Center (HC) III in the respective districts. UEC will scale up to include Lubaga, Kitovu, Kisubi, Bishop Assili and Angal Hospitals. The project will expands services for 17 faith-based hospitals and clinics and three community based organizations previously under the AIDS Relief program. Program activities will include: ART, HCT, VMMC, positive health dignity and prevention activities, integrated TB-HIV management, OVC and enhanced PMTCT. Under Global fund, community volunteers will be trained to sensitize their communities, give essential support.

The goal of the UEC project is to provide quality, accessible HIV services. Project objectives include ensuring that; HCFs provide quality HIV prevention services and safeguard the health of targeted communities, support and treatment services to targeted communities and Strengthened Health Systems.

The program will be implemented through an integrated approach utilizing existing systems and staff. The UEC will support HCFs to collect quality data, analyze it and generate periodical progress reports. In addition, regular audits will be conducted.

UEC plans to procure four vehicles this year. These vehicles will facilitate support to the diverse and hard to reach HCFs.

PEPFAR will focus on supporting the Government of Uganda (GOU) to further expand access to HIV care and support with the goal to achieve universal access of 80% in care by 2015. The Uganda Episcopal Conference (UEC) implementing the AIDS Care and Treatment (ACT) project will support the provision of care services to 49,029 individuals as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals receiving care and support services. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations such as truck drivers, fishermen and hard to reach populations. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. UEC will implement approaches to promote an effective CoR model and monitor key indicators along the continuum and will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthen positive health dignity and prevention, strengthen linkages and referrals using linkage facilitators, implement quality improvement for adherence and retention, pain and symptom management and provide support to targeted community outreaches in high prevalence hard to reach and underserved areas.

Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation in line with MoH guidance. This has been a major bottleneck to treatment scale up nationally. Working with the Central Public Health Laboratory and other stakeholders, CD4 coverage will be improved from the current 60% to 100% over the next 12 months. UEC 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 and will regularly keep track and ensure there will be no client wait lists.

UEC will work with PACE for provision and distribution of basic care kits to clients. UEC will also coordinate with the Joint Medical Stores and Medical Access Uganda Limited for other HIV commodities including cotrimoxazole and lab reagents. UEC will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

UEC will work with USG partners such as HEALTHQual 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 will take place.

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. UEC will work under the guidance of MoH/ACP and the Quality Assurance Department for trainings, mentorship and supportive supervision.

Funding will be provided to support the recruitment of additional staff in the participating health facilities to meet the achievement of the targets. This will be done in line with the recommendations from the Health Systems Strengthening technical working group.

The project will provide services to orphans and vulnerable children (OVC) in all the 18 Health Center Facilities (HCFs) and will use two entry points for identifying OVCs, the HIV clinics at all the LPTFs and the community using the vulnerability index tool. At the clinic, the program will identify and support the HIV+ children, as well as, orphans under the care of the adult clients. Support for OVCs at the facility level includes will include counseling, care and treatment. Through the community approach, trained health workers and volunteers will carry out community mobilization and sensitization at community and family level using existing structures like churches and religious leadership, community meetings, and youth peer groups. As a result, they will be able to identify 8,200 OVCs and link them to comprehensive OVC packages provided by the program.

Also at the facility level, HCFs will create a family-centered care environment, and enhanced community support systems, including support for OVC peer groups, foster homes and paralegal support. All HCFs will establish support groups for children and for adolescents. 70% of the facilities will have designated child friendly corners and child days that will be done quarterly. On child days, children will be grouped by age and age appropriate activities will be carried out. These activities will include sessions on discipline, behavior life skills, and leadership skills. Identification of skills and talents will also be done and identified OVCs will be linked to livelihood support programs such as vocational skills and apprenticeship. Additionally, adolescents will be trained in prevention activities, with a focus on abstinence.

In FY 2013 the project will provide 8,200 OVCs with comprehensive care services in priority program areas in line with MoGLSD guidelines. The OVC package will include education support, psychosocial support, economic strengthening, and food and nutrition interventions. A total of 2,800 OVC care givers selected from the all the HCFs will be trained in comprehensive OVC management while 114 health workers will complete an in service training program in OVC care services.

UEC will focus on supporting the GOU to scale up TB/HIV integration, and specifically the PEPFAR goal to achieve TB screening of 90% (731,690) of HIV positive clients in care. In addition, 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. UEC will contribute to this target by screening 44,126 HIV positive clients for TB; and 1,471 will be started on TB treatment. UEC will support 17 Catholic owned health facilities in all the 15 target districts

UEC will improve Intensified Case Findings (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. UEC will support MDR-TB surveillance through sputum sample transportation to Gene pert hubs and receipt of results at facilities.

In FY 2013, UEC will ensure early initiation of all HIV positive TB patients on ART through the use of linkage facilitators and/or the provision of ART in TB clinics. UEC 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.

The MOH/ACP and National TB and Leprosy Program (NTLP) will be supported to roll out provision of IPT, in line with the WHO recommendations.

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

The program will be aligned to the National Strategic Plan for HIV/AIDS and National TB Strategic Plan (2011/12-2014/15), support and strengthen the national M&E systems and work within district health plans. UEC will work under the guidance of MoH/ACP, NTLP and the Quality Assurance Department in trainings, TB/HIV mentorship and supportive supervision.

UEC will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

UEC will focus on supporting the GOU to further expand pediatric HIV care and OVC with the goal to achieve universal access to care by 2015. The UEC program will contribute 49,029 to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services of which 74,555 are children with ACT contributing 4,413. UEC will support 17 catholic owned health facilities in 15 districts.

UEC 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 to enable early enrolment of children in care. A focus will be on scaling up low cost approaches, such as use of care taker support groups so as to support retention in care. UEC 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 guidance.

UEC will support retention of adolescents in care as well as ensure a smooth transition into adult life using expert peers and adolescent support groups. They will be provided with positive health dignity and prevention services including, sexual and reproductive health services, psychosocial support and life skills training. Lessons learned from the planned national adolescent service assessment will be incorporated in activities.

A key priority will be to establish strong referrals between OVC and care and support programs to ensure HIV positive children are linked to OVC services, and children provided with OVC services are screened for HIV and appropriately linked to care and support. UEC will also support the integration of HIV services in routine pediatric health services, including the National Child Health Days.

UEC will liaise with PACE for provision and distribution of basic care kits to clients. In addition, UEC will coordinate with Joint Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities including cotrimoxazole and lab reagents. UEC will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

UEC 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. UEC 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/AIDS (2011/12-2014/15), support and strengthen the national M&E systems and work within district health plans. UEC will work under the guidance of MoH/ACP and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework 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 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 ART targeted population receiving CD4 tests to increase coverage from 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, result 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.

Implementation of the WHO Strengthening Laboratory Management Towards Accreditation (SLMTA) will be the mainstay for quality improvement in addition to other quality assurance activities.

The hubs are strategically located health facilities identified by the MoH to serve as coordination centers for specimen referral, testing and result transmission for a catchment area of 30km to 40km radius serving 20 to 50 facilities.

UEC will support maintain Aber Hospital in Oyam District Northern Uganda as a specimen transportation, testing and result transmission hub. The support includes: carrying out major renovations in the hub; the recruitment of two Lab Technologists and one Technician. The mechanism will also build capacity for the hub to carry out CD4, clinical chemistry and hematology tests by procuring the equipment and associated requirements.

These will also continue to participate in the UKNEQAS external assessment scheme for CD4 testing in addition to internal continuous Quality Improvement initiatives including the Small test of change through HealthQual and HCI. Once the hub at Aber Hospital is fully functional, UEC will strengthen and harmonize the support they are already providing to the current 14 health facilities, and will expand to a total of 17 facilities in 14 districts by the end of 2012. UEC supported facilities will continue to benefit from the supply chain management services provided by MAUL and also make use of the regional Equipment Maintenance workshops to be supported by SUSTAIN.

Given the results of the USAIS (2010/2011) with alarming increase in HIV prevalence and very low circumcision prevalence (approx 25%), PEPFAR Uganda is prioritizing this prevention intervention as a major pivot to reduce the number of new HIV infections.

UEC will provide Voluntary Medical Male Circumcision (VMMC) as part of the comprehensive HIV prevention package which includes: promoting delay of sexual debut or primary abstinence, abstinence and partner reduction and being faithful, condom promotion correct and consistent use of male condoms campaigns, providing HIV testing and counseling services and refer to appropriate care and treatment if necessary. Treatment services for sexually transmitted infections in all the 17 supported Health Care Facilities (HCF) will also be provided.

UEC will employ both media campaigns and person to person message packaging to target male and female partners to increase testing uptake. Community mobilisers will target localities with high numbers of men like markets, taxi parks, boda boda stages.

UEC will implement the Model to Optimizing Volume for Efficiency (MOVE) and increase VMMC services uptake at all supported HCFs.

Special focus will be placed on quality assurance and regular quality assessments (internal and external) of the VMMC program will be done and daily reports sent to the SMC National Operational Center as required by MoH.

The MoH policy guidelines on VMMC will guide the integration of VMMC services in Ugandas national health system. Through these established policy guidelines on SMC UEC will contribute to the national SMC target of 1 million circumcisions in 2012/2013.

In FY 2013, UEC will offer adult care and support services through 17 Health Care Facilities (HCFs), distributed across Uganda in some of the most underserved and rural areas. In addition, the partner has been funded to promote a range of behavioral activities to reduce HIV transmission, for both in-school and out of school youth.

The interventions are stand-alone to reduce the HIV sexual risk behavior: promote primary abstinence among the youth, encourage delay of sexual debut, promote fidelity and monogamy (partner reduction). For sexually active youth the interventions will focus on risk reduction counseling including secondary abstinence, and biomedical prevention interventions at targeted Health care Facilities and churches after prayers.

UEC will use various channels to communicate a range of messages to promote abstinence, and delay of sexual debut. The messages are developed according to the National Prevention Strategy, and approved by UAC and MoH. The messages are being delivered at the individual level (interpersonal level), community level in collaboration with community based organizations like; Comboni Samaritan in Gulu, Meeting Point and Christian HIV/AIDS Prevention and Support (CHAPS) to build behavior change activities into their strong community networks following the Ugandan MoH guidelines.

The program will ensure that AB activities are integrated into PMTCT, OVC Care and treatment activities at all the 17 HCFs. Pregnant women who test negative in ANC will also be encouraged to attend these risk reduction counseling sessions with their partners

In FY 2013 a total of 14,401 individuals (youth in and out of school) will be reached and 25 church small using group sessions will held using targeted massages AB.

The goal of the UEC AIDS Care and Treatment (ACT) Program is to provide High quality accessible HIV services in an integrated and strengthened health care system working with faith based local partners in 17 health care facilities situated 15 districts across Uganda.

In FY 2013 the program will offer HIV Testing and Counseling (HTC) to 60,000 individuals and contribute to the overall PEPFAR HTC goals by increasing access to and use of essential counseling and testing services to pregnant and breast feeding mothers in ANC settings, at labor, delivery and post-partum.

In addition, male partners, families and the general population will be targeted based on existing HIV prevalence data and unmet need. The program will scale up Provider or Client Initiated Testing and Counseling (P/CITC) at all implementing sites with same visit return of results and will use innovative outreach approaches to reach key populations in the community including special services for couples. Community and political leaders will be engaged. This program will contribute to the continuum of response by actively linking clients to other health services including HIV care and treatment and social support services in the community thereby increasing demand and retention in care.

The UEC will implement this program through an integrated approach utilizing existing systems and staff and will promote cost efficiency through: hiring local staff, using national treatment guidelines and a lean staffing technical assistance model with locally sourced expertise to provide technical backstopping.

Health care facilities (HCFs) will collect routine quality data, analyze it and generate periodical progress reports that will be shared with stakeholders including: implementing partners, districts, MoH, and regular data quality audits will be conducted to maintain high quality data.

Additionally, in order to maximize program success, this program will work towards evidence gathering for the purpose of standardizing service delivery, to ensure consistency with World Health Organizations HTC Quality Assurance/Quality Improvement guidelines

Four vehicles will be procured during the year. These vehicles are to facilitate technical assistance and support supervision missions to the diverse and hard to reach HCFs.

The HTC program activities shall be conducted in partnership with local district governments under stewardship of the MoH, recognizing that the scale-up of activities will require a continued commitment by the USG.

In FY 2013, the UEC project will facilitate the roll out and implementation of PMTCT Option B+ activities in 17 Health care facilities.

PMTCT program shifts will include:

1) Improving access to and utilization of eMTCT services in order to reach more HIV positive pregnant women as early as possible during pregnancy. This will be achieved through provision of universal HTC services during ANC, labor and delivery, and community mobilization.

2) Decentralizing Option B+ and Treatment services through accreditation of all PMTCT sites at hospital; Health Center (HC) IV and HC 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 targeted sites will be done in accordance with MOH guidance and four sites will be accredited by end of FY 2013.

UEC will use a Family Focused model within MNCH settings where by support groups at all PMTCT sites are to meet monthly to receive adherence counseling and psycho-social support, IYCF counseling, EID, FP counseling, couples HTC; supported disclosure and ARV refills. Village health teams (VHTs) will also be engaged 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. At least 12,500 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 for appointments, EID results, and ARV adherence. Service providers will conduct home visits to trace client who are lost to follow-up. All sites will submit daily reports on key program elements electronically to support effective monitoring and timely management.

4) Facilitating quarterly joint support supervision and mentorships at all PMTCT/ART sites involving MOH, AIDS Development partners, Districts, USG, and IP staffs 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) UEC will not provide family planning services directly to clients since its a catholic based institution but will work with other partners like MSI and UHMG to ensure that those who need the services are referred to trained service outlets.

The Program will provide HIV counseling and testing to 25,000 pregnant women in 14 service outlets during FY 2013. A total of 2,075 HIV positive pregnant women will be identified, of which 1,764 will be initiated on HAART for life and 311 will be provided with ARV prophylaxis; in addition, 2,012 will receive ARV prophylaxis and DNA/PCR test will be done for 2,012 of exposed babies.

UEC will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. The UEC program will enroll at least 12,554 new clients and support 30,076 adults and children on ART by APR 2013, contributing to overall national and PEPFAR target of 190,804 new clients and 490,028 individuals current on treatment. This target is not a ceiling, allowing for higher achievements with continued program efficiencies. Priority will be given to enrolment of HIV positive pregnant women, TB/HIV patients, and key populations in Catholic owned facilities in 15 districts.

UEC will support the MoH roll out of Option B+ for eMTCT through the following activities: accreditation of 24 additional health facilities; training, mentorship and joint PMTCT/ART support supervision. UEC will also support ART/PMTCT integration at facility level piloting feasible service delivery models, such as same day integrated HIV clinics.

Continuum of response linkages and referrals will be strengthened using linkage facilitators across different service points in facilities and communities. Facilitators will also be utilized for TB/HIV integration to ensure early ART initiation for TB/HIV patients. UEC will support reproductive health integration including maternal and child health and cervical cancer screening at facility level through provision of the services or referrals. Targeted community outreaches in high prevalence hard to reach and underserved areas of will be conducted. UEC will also target key populations using innovative approaches including setting up specialized services; such as moonlight services for commercial sex workers. UEC will implement quality improvement initiatives for the ART framework: early initiation of ART eligible clients on treatment; improve adherence and retention; and monitor treatment outcomes. Use of innovative, low cost approaches for adherence, retention and follow up such as: phone/SMS reminders, appointment registers, alert stickers will be supported. Special focus will be placed on adherence and retention of women enrolled under Option B+. An emphasis will be placed on increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. U EC 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. UEC will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. UEC will work with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for ARVs and other HIV commodities including cotrimoxazole and lab reagents. UEC will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.UEC will work with USG partners and other key stakeholders for provision of required wrap around services. The program will be aligned to the National Strategic Plan for HIV/AID (2011/12-2014/15), support and strengthen the national M&E systems and work within district health plans. UEC will work under the guidance of MoH/ACP and the Quality Assurance Department in trainings, ART/PMTCT mentorship and supportive supervision. Funding will be provided to support the recruitment of additional staff in the supported health facilities to meet the proposed targets. This will be done in accordance to the HSS TWG guidance.

UEC will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. The UEC project will enroll at least 1,130 new HIV positive children and support 4910 children on ART by APR 2013. This will contribute to overall national and PEPFAR target of 39,799 new clients and 64,072 children current on treatment.

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

UEC 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 helath dignity and prevention services including: sexual and reproductive health services, psychosocial support and life skills training.

A key priority will be to establish strong referrals between OVC and care and support programs to ensure children on treatment are linked to OVC services, and children provided with OVC services are screened for HIV and appropriately linked to treatment. UEC will support the integration of HIV services in routine pediatric health services, including the National Child Health Days.

UEC will liaise with PACE for provision and distribution of basic care kits to clients. UEC will also work with Joint Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities including cotrimoxazole and lab reagents. UEC will build the capacity of facility staff to accurately report, forecast, quantifies and order commodities in a timely manner.

In addition, UEC 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. UEC 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. UEC will work under the guidance of MoH/ACP and the Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework and supportive supervision.

Funding will be provided to support the recruitment of additional staff in the participating health facilities to meet the proposed targets. This will be done working with the guidance from the Health Systems Strengthening technical working group.