Childrens AIDS Fund-Uganda (CAF-U) implements the New Hope Project through four HIV clinics namely Family Hope Center Kampala district, Family Hope Center Jinja district, Kabwohe Clinical Research Centre in Mitooma District, and Bushenyi Medical Centre in Bushenyi District.

CAF-U has been supporting the four Implementing Health Facilities (IHF) to provide ART to 11,310 clients cumulatively since 2004. Other services include: HIV Counseling and Testing (HCT), ART and care, TB diagnosis and treatment, Positive, Health, Dignity and Prevention (PHDP), OI management, Behavior Change Communication (BCC), OVC care and support, HMIS support, nutrition and food security, community and adherence outreach, immunization, family planning services, cervical cancer screening and STI diagnosis and treatment.

The main goal of the project is to provide comprehensive HIV/AIDS care, treatment and prevention services in indigenous health facilities of Uganda, thereby strengthening capacity to achieve sustainability, as well as, national and PEPFAR goals.

IN FY 2012 CAF-U will implement a project called New Hope Project through the existing four IHFs with 15 outreach sites and expand to three new IHF namely Namugongo Special Fund for Children and Nurture Africa clinic in Nansana in Wakiso district and Alive Medical Center in Kampala.

Over the project period, CAF-U will scale up to support comprehensive HIV/AIDS care and support services to 11,300 individuals. Target expansion sites are based on a mapping exercise undertaken by USG based on identified service gaps.

CAF-U will purchase two motor vehicles for use in project implementation, monitoring and evaluation, coordination and operations including administrative and oversight functions over implementing health facilities.

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. CAF-U will support the provision of care services to 11,300 clients 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. CAF-U will give specific attention to key populations such as truck drivers, fishermen, commercial sex workers and men who have sex with men. A Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. CAF-U will implement approaches to promote an effective CoR model and monitor key indicators along the continuum.

CAF-U through seven Implementing Health Facilities (IHF) located in five districts of Uganda; Kampala, Jinja, Mitooma, Bushenyi and Wakiso will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance.

Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation in line with MoH guidelines. 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 60% currently to 100% over the next 12 months. CAF-U will support the sample referral network in line with the national CD4 expansion plan, and will monitor and report clients access to CD4 in quarterly reports keeping track and ensuring there are no client waiting lists.

CAF-U will liaise with PACE for provision and distribution of basic care kits to clients. Additionally, liaise with Joint Medical Stores and Medical Access Uganda Limited for other HIV commodities (cotrimoxazole, lab reagents). CAF-U will build the capacity of facility staff to accurately and in a timely manner report, forecast, quantify and order commodities.

In addition, UPMB will work with USG partners for linkage to OVC services such as PIN, SPRING, HEALTHQual for CQI, 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 occur.

CAF-U working with MoGLSD will address the linkages between GBV and HIV, including tracking linkages to services for survivors of sexual violence, provision of post-exposure prophylaxis, treatment of sexually transmitted infections, and reproductive health counseling and services. As well, UPMB will support gender equity training for program managers, counselors, and M&E officers at a minimum will receive training to include gender-equity indicators and systematically audit gender equity performance

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

Funding will be provided to support the recruitment of additional staff in the IMFs through the districts to meet the achievement of the targets. This will be done in collaboration with the Health Systems Strengthening technical working group.

CAF-U 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. CAF-U will contribute to this target by screening 10,170 HIV positive clients for TB, and 339 will be started on TB treatment. CAF-U will work in five districts of Wakiso, Kampala, Bushenyi, Mitooma and Jinja.

CAF-U 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. CAF-U will support MDR-TB surveillance through sputum sample transportation to GeneXpert hubs and receipt of results at facilities.

In FY 2012, CAF-U 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. CAF-U will increase focus on adherence and completion of TB treatment, including DOTS through the 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 monitor and ensuring adequate natural ventilation.

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

CAF-U 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. CAF-U will work under the guidance of MoH/ACP, NTLP and the Quality Assurance Department in trainings, TB/HIV mentorship and supportive supervision.

Additionally, CAF-U will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

CAF-U 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. CAF-U will contribute 1,017 to the overall PEPFAR target of 74,555 HIV positive children receiving care and support services.

CAF-U 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 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 caretaker support groups so as to support retention in care. CAF-U 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.

CAF-U 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 will be screened for HIV and appropriately linked to care and support. CAF-U will also support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

CAF-U will liaise with PACE for provision and distribution of basic care kits to clients and liaise with Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). CAF-U will build the capacity of facility staff to report, forecast, quantify and order commodities accurately and timely.

CAF-U will work with USG partners such as SCORE, SUNRISE, PIN, SPRING for OVC support, HEALTHQual for CQI and others in their related technical areas to support integration with other health like nutrition services. CAF-UP 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. CAF-U will work under the guidance of MoH/ACP and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and supportive supervision.

The CAF-U objective under the New Hope Project is to provide HIV prevention, care, treatment, and support services; and strengthening health systems for sustainable and integrated quality HIV services through the private sector. The project will increase access to HIV Counseling and Testing (HCT) by providing HCT services to over 6,000 individuals and improving health workforce capacity targeting seven indigenous health care facilities in Kabarole, Kampala, Jinja, Wakiso and Bushenyi districts. In addition, Provider Initiated Counseling and Testing (PICT) will be integrated into routine health care at all implementing sites and will use innovative outreach approaches in the community to target key populations including special services for couples.

A continuum of response will be ensured by actively linking clients between MNCH, out patients and inpatients departments and to other HIV services targeting 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. This will increase demand and enrolment into care

CAF-U will make HCT available at lower-level satellite sites and train local health workers at those sites in developing and implementing gender-sensitive HCT protocols. In addition, health workers will carry out monthly community-based HCT outreach for children and adults following the MoH guidelines. Routine quality data will be collected and analyzed to generate periodic progress reports that to be shared with stake holders including: local governments, implementing partners and MoH.

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.

In order to maximize program success, this program will work towards gathering evidence for the purpose of standardizing service delivery using World Health Organization HTC Quality Assurance/Quality Improvement guidelines.

CAF-U will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. CAF-U will enroll at least 2,658 new clients and support 6,989 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 it allows for higher achievements with continued program efficiencies. Priority will be given to enrolment of HIV positive pregnant women, TB/HIV patients, and key populations. CAF-U will work in five districts of Uganda: Wakiso, Kampala, Jinja, Mitooma, and Bushenyi.

CAF-U will support the MoH roll out of Option B+ for eMTCT through the following activities: implement Option B+ at Implementing Health Facilities (IHF) offering antenatal and maternity services, training, mentorship and joint PMTCT/ART support supervision. CAF-U 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. CAF-U will support RH integration including family planning and cervical cancer screening at facility level through provision of the services or referrals.

CAF-U will hold targeted community outreach activities in high prevalence hard to reach and underserved areas of Bushenyi and will also target key populations using innovative approaches including setting up specialized services, such as moonlight services.

CAF-U 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. The use of innovative, low cost approaches for adherence, retention and follow up such as: phone/SMS reminders, appointment registers.

Special focus will be placed on adherence and retention of women enrolled under Option B+. Focus will be placed on increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. CAF-U 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. CAF-U will liaise with PACE for provision and distribution of basic care kits to clients, as well as, with Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents) and CAF-U will build the capacity of facility staff to report, forecast, quantify and order commodities both accurately and timely. In addition, CAF-U 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. CAF-U 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 IHFs through the districts to meet the achievement of the targets. This will be done in collaboration with the Health Systems Strengthening technical working group.

CAF-U will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. CAF-U will enroll at least 239 new HIV positive children and support at least 908 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. CAF-U will work in five districts of Uganda; Wakiso, Kampala, Jinja, Mitooma, and Bushenyi.

In FY 2012, CAF-U will support the national program to scale up pediatric treatment through strengthening the identification, follow up and treatment for all infants through early infant diagnosis 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.

CAF-U 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 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. CAF-U will support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

CAF-U will liaise with PACE for provision and distribution of basic care kits to clients and liaise and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). CAF-U will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

In addition, CAF-U will work with USG partners such as SCORE, SUNRISE, PIN, SPRING for OVC support, HEALTHQual for CQI and others in their related technical areas to support integration with other health, nutrition and OVC services. CAF-U 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. CAF-U 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 IHF through districts to meet the achievement of the targets. This will be done in collaboration with the Health Systems Strengthening technical working group.