Kalangala District Local Government received CDC/PEPFAR funds to implement a community and home based approach confidential Voluntary HIV Counselling and Testing and basic care in Kalangala District and surrounding fishing communities of Lake Victoria from January 1, 2008 to December 31, 2012. Goal: To contribute to the reduction of HIV infection rate and mitigate the impact of HIV in Kalangala District and the surrounding fishing communities. Overall Objective: To provide TB/HIV, counselling and testing, clinical care/ ARV services, palliative care, AB and other prevention services to at risk populations (adults and children) in Kalangala district and the surrounding communities of Lake Victoria in Uganda.

The program works in Kalangala district and has scaled up to various districts; such as Rakai, Masaka, Kalungu, Mpigi and Gomba districts targeting fishing communities surrounding Lake Victoria. The program purchased a Toyota Land cruiser 4C Hardtop, Station Wagon, model HZJ78R-RJMRS and two 4- Wheel Drive Pick up Double Cabin Pick up for field activities which are in good shape and expected to serve for another year or two and will be disposed of after five years as per the GOU guidelines. The program with national and PEPFAR reporting requirements and ensures that quarterly progress and annual financial reports are submitted to CDC/PEPFAR.

With FY 2012 funds, we shall consolidate Home Based HCT, Positive Health Dignity Prevention (PHDP) interventions, Sexual prevention, ARV drugs, HIV/AIDS Clinical Care, follow up HIV positives clients and discordant couples, support CD4 services and TB/HIV interventions. The program will also continue to strengthen health systems in all program districts and referral for comprehensive HIV/AIDS services.

In FY 2011, The program has reached 6031 (3696 males and 2335 females) HIV positive individuals and these were provided with basic and HIV/AIDS palliative care services in the operational districts of Kalangala, Kalungu, Masaka, Mpigi and Rakai districts. This included; assessment of sexual activity and provision of condoms, partner testing or referral, assessment and support for ART adherence, and enrollment into community support programs e.g. Post Test Clubs. strengthening partner disclosure and partner testing, Psychosocial support/counseling, Promote/ provide / refer for PMTCT (MCH/RH), Behavior risk reduction ; safe sex practices ( correct and consistent condom use; prevention of alcohol use, Secondary abstinence option-voluntary not imposed, SDC counseling , partner reduction), Nutrition (balanced diet, increase risk perception, Community peer Support Groups, Prevent OIs-safe water vessel systems/ mosquito bednets, Refer for SMC for SDCs (male spouse is HIV negative) and referral for palliative care. Linkages to Kalangala HCIV, Kalisizo, Masaka, Entebbe and Kitovu Hospitals on the mainland for more specialized care were enhanced. A referral card was issued and endorsed by the referral facility for the services provided for tracking purposes.

In FY 2012, the program will provide access to basic and palliative HIV/AIDS care services and support to PHAs 3602 (1530 females; 2072 males) in Kalangala, Rakai, Kalungu, Masaka, Mpigi and Gomba districts. In the areas that we have fully covered over the current FY11, we shall serve them on a call back mechanism. In collaboration with other partners, HCs will be strengthened to continue providing support and care services for sustainability services. Cotrimoxazole, treatment of OI, and diagnosis and treatment of Malaria, palliative care kits (Mackintosh, one blanket, one box of disposable gloves, 1 bar of washing soap, 2 pieces of dettol soap, one pair of bedsheet) and palliative care medicines for the terminally ill/ bedridden clients (codeine, morphine and other items used in palliative care) will be provided. VHTs will be supported and used to follow up patients and support facility- community linkages to improve retention in care and reduce loss to follow up. This will be integrated into other VHT activities that contribute to improving the general health in alignment with the GHI principles. The program will continue to work with PACE to obtain safe water vessels, bednets and condoms as needed for patients. Partnerships with PREFA, MARIE STOPES and STRIDES for services such as family planning and PMTCT (RH/MCH) will be enhanced. Health workers will be trained on the new STI guidelines and the program will support the availability of the drugs. Sensitization of target communities about availability of CD4 services at Kalangala HC IV will be done to strengthen services. Laboratory reagents for CD4/TB diagnostic services will continue to be procured. Linkages for nutritional assessment support and follow up will be maintained. Strengthening the integration of Positive Health Dignity and Prevention (PHDP) interventions into care and support services will be done at community and facility levels. Local mentorship of health workers in data capture, analysis, quantification and requisition of drugs and other commodities from NMS will be fostered. Supervision and monitoring of the services provided will be conducted by program management.

Kalangala district has a high concentration of orphans and vulnerable children (OVC) largely attributable to the districts high HIV/AIDS prevalence. The district has an estimated 7,463 OVCs representing 12% of the total population of which 1,439 are critically vulnerable, 3,458 moderately vulnerable and 2,466 generally vulnerable (Recent survey by Ministry of Gender Labor and Social Development (MoGLSD). A significant number of children and adolescents have lost one or both of their parents to HIV/AIDS and are cared for by surviving parents of which majority are widows or grandparents. The majorities of the children live in poor households and are unable to afford schooling or medical services.

In FY 2013, and given the available funding, OVCs at Health Centers (HC) and at community levels will be identified using the newly developed Vulnerability Index Guidance developed by PEPFAR OVC TWG in collaboration with MoGLSD, UNICEF and other key players. The district will identify and link critically vulnerable 1,000 OVCs (400 females and 600 males) to comprehensive OVC packages in line with the MoGLSD guidelines. The program will identify and support all the HIV positive OVC under the care of the adult clients. OVCs facility activities include counseling, care and treatment and community activities will include community mobilization and sensitization by probation/community development officers, trained HWS and volunteers at community and family level using existing structures. A family-centered care environment, enhanced community support systems, support for OVC peer groups, foster homes and paralegal support will be initiated. All HCs will establish support groups for OVCs. All the 11 HCs will have designated child friendly corners and child days on a quarterly basis whereby children will be grouped by age and age appropriate activities will be carried out. Sessions on discipline, behavior life skills, and leadership skills, identification of skills and talents will 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, using the Value of Life Curriculum, with a focus on abstinence.

The services will include: food/ nutrition, shelter and care, protection and legal aid, health care and psychosocial support, nutritional assessment and counseling, therapeutic and supplementary feeding for malnourished children, strengthening family based care models for children, supporting child headed households, referrals and linkages to child health care including appropriate ART, growth monitoring, immunization, malaria prevention, sanitation and clean water, and personal hygiene and age appropriate prevention activities. Psychosocial services will include gender- sensitive life skills; improving links between children affected by HIV/AIDS in their communities, referral for counseling for anxiety, grief and trauma. Teenage pregnancies, SGBV, rape and PMTCT services for teenage mothers will be integrated in the OVC interventions. 100 OVC care givers will be selected from all islands that make up the district for coaching and mentoring in comprehensive OVC management while 30 in service health workers will be coached and mentored in OVC care services. Implementation, supervision and monitoring of OVC program will be done by responsible district staff.

Kalangala HBVCT provided integrated TB/HIV services in all the 11 health facilities within Kalangala district. The key accomplishments in FY 2011 included training in TB/HIV service integration (TB screening, HCT for TB patients and ART for TB patients), refresher in TB Microscopy for 11 health workers from health centres within Kalangala district, procurement of seven (7) light and electric microscopes, distribution of the same to health centres within Kalangala district, implementation of TB quality assurance, procurement of buffer stock of TB related laboratory supplies including support for TB/HIV service integration to further enhance TB/HIV service provision. Hence, over 2890 were screened for TB in HIV care or treatment settings and suspects had sputum examined by microscopy with those that had TB positive smears linked to TB treatment and support services. In order to ease service provision, 11 health centres were fully facilitated to provide TB services. Working with the NTLP of the MoH all health units in Kalangala were stocked with TB medicines and related supplies.

Given the estimated HIV prevalence of 20%, we expect to get 5,512 HIV Positive clients out of the 27,562 to be tested. Of 5512 clients, about 386 (7%) will be expected to be with TB. All the identified TB patients (386; 100%) will be screened for HIV and their HIV test results recorded in the TB register; 232 males & 154 females when the male: female sex ratio of 1.5:1 is applied. The same will apply for number HIV positive incident TB cases that will receive treatment for TB and HIV during the reporting period.

The programme will continue to ensure that all HIV positive patients are referred to chronic care clinics where TB screening is routinely done. In addition we shall conduct a training of 30 community TB/HIV volunteers (DOTS) in TB/HIV collaborative activities for Community Volunteers. Community TB DOTS providers will be supported to increase adherence. Efforts for cross-referral and integrated diagnosis, treatment, and support services for TB and HIV in targeted health facilities mainly in Kalangala, Rakai, Masaka and Kalungu districts will be enhanced. Support for health facilities to provide a family-centered approach to diagnosis and treatment of TB with a strong focus on intensified case finding and Infection control will be enhanced. HIV prevention messages, such as avoidance of high risk behaviors and secondary prevention, will also be integrated into counseling and testing sessions for TB patients. In collaboration with the PEPFAR laboratory strengthening initiative, this programme will continue to contribute to the functionality of health facilities laboratory capacity for TB and HIV including an assessment of laboratory capacities at targeted facilities to identify areas in need of priority actions. The assessment will examine availability of laboratory staff and their level of training/experience, number and types of laboratory services currently available (with an emphasis on HIV/AIDS and TB diseases), current infrastructure, availability of supplies and supply-chain, availability of operating procedures and protocols for laboratory management and performance, and the level of resources allocated to laboratory performance by district planning committees. A plan to address the gaps identified will then be developed according to MOH guidelines and implemented in collaboration with the National TB and Leprosy Program.

Children under 18 years are projected to be 20,800 (2002 Census) of which 3536 were estimated to be HIV positive based on 17% HIV prevalence and 50 % (1768) were reasonably targeted in FY 2011 whereby 1158 (65%) were served. Kalangala HBVCT supported scale- up of paediatric care and support services through support for ART treatment outreaches and adherence follow up for HIV infected infants, children and adolescents on ART. Twenty eight (28) health workers within Kalangala district were trained in Early Infant Diagnosis (EID). Two EID clinics were set up at Kalangala and Bukasa HCIVs and later 9 evolved at the lower health centres. ART teams at Kalangala Health Centre IV conducted monthly ART treatment outreaches and adherence follow ups to 8 health centres deep in the islands of Kalangala District.

Health workers will be supported to collection DBS samples from children during immunization outreaches; follow up on HIV+ mothers who are delivered at the health units or elsewhere for HIV PCR and ELISA testing using FY 2012 funds. All HIV exposed infants shall be given cotrimoxazole syrups and followed up until they are able to access comprehensive HIV/AIDS Care if found HIV positive. The program proposes to reach 482 HIV exposed infants with an HIV test within 12 months of birth and ensure 482 HIV exposed infants are started on cotrimoxazole prophylaxis within two months of birth. All Pregnant women will be screened at ANC clinics and encouraged to deliver in Health Centres. All those found to be HIV positive will be linked to PMTCT services, followed up and enrolled into comprehensive HIV/AIDS care. EID interventions, ART, care for OIs, and cotrimoxazole prophylaxis, nutritional support and growth monitoring will be enhanced. Working with Kalangala PHA Forum, community interventions to track mother-infant pairs will be emphasized for at least 87% of all the exposed infants. Child and adolescent friendly corners will be established at 11 Health units through for HIV infected children, transitioning adolescents and adolescents to access Positive Health Dignity and Prevention (PHDP) interventions, HIV care including RH/ family planning services, HIV prevention and psychosocial support. Laboratory & clinical monitoring of children and adolescents on Pre- ART or ART will be supported at targeted health units in addition to support for treatment adherence. Post test clubs for Adolescents for disclosure and strengthening adherence will be supported. VHTs will be supported to sensitize care givers of children and adolescents on HIV/AIDS, ART and adherence to minimize loss to follow up. Support supervision to health units by the DHT will be facilitated and technical support for health workers in proper documentation, report compilation and evaluation of the quality of care provided.

Opportunistic infections medicines that are critical in Pediatric HIV/AIDS care will be procured. Laboratory & clinical monitoring of children and adolescents on Pre- ART or ART will be supported in addition to support for treatment adherence. Collaborative linkages will be maintained with health units in the mainland, including Kalisiizo hospital, Bukulula health centre IV, Masaka and Kitovu Hospitals, for more specialized care. The programme will procure buffer supplies of ARVs (Pediatric formulations) for targeted Health centre IVs to back up the inadequate supplies from Ministry of Health.

The program implemented targeted HIV prevention interventions focused on promoting abstinence and be faithful (AB) aimed at stemming HIV infections among individuals (in and out of school), couples, and families. A variety of communication channels such as drama, community meetings, individual one on one meetings were applied to reach target groups in the dissemination of preventive messages to the communities. Hence in FY 2011, 5444 (2460 females; 2984 males) individuals were reached with individual or small group preventive interventions that are focused on AB only.

In FY 2012, the program will continue with the implementation of AB interventions among individuals, couples and families targeted with HCT in the operational districts (Kalangala, Masaka and Rakai districts) with a view to increasing the number of volunteers trained to conduct these activities. The objectives of this component will be to provide targeted community behavior change communication interventions aimed at stemming HIV infections among individuals, couples, and families to promote abstinence, including delay of sexual activity or secondary abstinence, fidelity, reducing multiple partners and concurrent partners, and related social and community norms that influence these behaviors. This activity proposes to reach approximately 5943 individuals (2414 females; 3529 males) with AB interventions and 5553 (2328 females: 3225 males), Most at Risk population groups with individual or small group HIV prevention interventions. The activities will include the continued training of 80 volunteers to conduct prevention education to patients, training and use of peers, field teams and volunteers to disseminate AB prevention messages and the use of communication strategies to reach target groups to disseminate AB HIV prevention messages, mobilization for VCT/ HCT uptake, sensitization and referral to AMREF supported clinics for Safe medical Circumcision, assessment and treatment of STIs with emphasis on partner notification. In partnership with AMREF, we shall ensure that all health centre IIIs and above in our catchment area are able to conduct SMC.

Abstinence messages will be disseminated to age groups 10 to 14 years through school based programs. The project will work closely with the District Directorate of Health Services, education department and other stakeholders to disseminate messages that encourage staying in school, delaying sex and promote life skills. Be-faithful messages will be disseminated to age groups 15 years and above and also to the married/cohabiting people. Working with local community groups, the program will support the set-up and/or strengthening of community-based support groups and post-test clubs to assist in providing psychosocial support to persons who have accessed HIV testing. Support supervision and monitoring of HIV prevention team will be enabled by program management to ensure realization of outputs and assessment of the quality of services provided to the beneficiaries.

Kalangala District, in Central Uganda is comprised of 84 Islands in Lake Victoria of which 64 to 76 are permanently habited due to fish migratory patterns. Kalangalas unique geographical location has resulted in limited health and human services to this marginalized population of 36,661 (2002 Census) and projected population of 100,000 people. The district is served by only eleven health units: two Health Centre (HC) IVs, six HC IIIs and three HC IIs and no hospital within the district. Referrals for complicated health problems are made to mainland Entebbe, Kitovu, and Masaka Regional Referral Hospitals which is 80 kilometers from the main island. The secondary analysis of the USHBS central region data indicate that Kalangala District, has a prevalence of 27% which is approximately five times the national average, thus this population of fishermen and their families have been identified as a very-high risk group.

In FY 2011, we supported door-to-door HIV Counseling and Testing (HCT) targeting all eligible family members including support for buffer stock of HIV test kits to target facilities within Kalangala district in periods of stock outs. Acceptance of HCT in homes was greater than 98% and this door-to-door HIV Counseling and Testing initiative is being provided throughout Kalangala, Mpigi and Gomba districts. In collaboration with TASO/SCOT, the program supported a refresher training in HBVCT for 26 field teams to enable them carry out HIV/AIDS education, home-based HIV Counseling and Testing (HBHCT) as well as community and family based HIV/AIDS activities including the provision of the basic care package, linkages to care and treatment and integration of HIV testing and TB screening. Field HIV Counseling and Testing (HCT) teams comprise a counselor and laboratory assistant who conduct counseling and testing services in clients homes. Community mobilization and support is conducted by a team of 100 Community Owned Resource Persons (CORPS)/ Mobilisers that have been identified by the communities served and trained in HBHCT activities. From January to September 20th 2011, overall 18,577 (71% coverage) individuals were counseled, tested and received their HIV results in their homes on the mainland as well as along the landing sites in Lake Victoria; 9813 males and 8764 females at 23 service outlets of Mpigi, Kalangala and Gomba districts. Of the total tested for HIV, 2972; 16% were HIV positive and the rest 15,605 were HIV negative. This program also enhanced partnerships with community based organizations (CBOs) and NGOs operating in HIV/AIDS services delivery in the district, thus building capacity and infrastructure for sustainable services.

With FY 2012 funds, the program will consolidate the door-to-door HCT initiative in Kalangala, Rakai and Masaka districts through a mapping exercise for areas with critical need due to the continuous migratory patterns of fishing communities. This activity proposes to reach 27,562 adults and eligible children (11714 males; 15848 males) at 28 service outlets with HBHCT services. The program will strengthen partnerships with other CBOs, NGOs (AMREF; KAFOPHAN), and public health facilities ( Kalangala Health Centre IV, Masaka hospital) providing health services in the project areas to increase capacity to provide comprehensive HIV/AIDS services as needed.

With the new budget period, the programme activities will continue to reach individuals, couples and families with other prevention activities and continue to support other HIV prevention approaches including Prevention with Positives (PWP) interventions targeted with HCT in the operational districts (Kalangala, Masaka and Rakai districts) with a view to increasing the number of volunteers trained to conduct these activities. We shall facilitate a training of 30 health workers in the management of STIs using the new STI guidelines. We shall also facilitate health units with STI medicines and supplies for proper management of STIs.

Five thousand five hundred fifty three Most at Risk population groups (2328 females; 3225 males) will be served. The activities will include: mobilization for VCT/ HCT uptake, continued training of 80 volunteers to conduct prevention education to patients, training and use of peers, field teams and volunteers to disseminate ABC prevention messages and use appropriate communication strategies to sensitize on GBV especially sexual violence, child defilement, Safe male Circumcision, PMTCT, STI and refer for other care to AMREF/PREFA supported clinics for SMC, PMTCT, assessment and treatment of STIs with emphasis on early recognition, partner notification and treatment seeking practices. The program will strengthen linkages by providing referral forms and ensure that clients actually access the services by involving women to motivate clients, seek SMC services, and, also support linkages of HIV positive persons to facilities which provide HIV/AIDS care, treatment and support.

Interventions targeting MARPS, condom promotion and distribution within the operational sites will be provided. Forty seven (47) condom outlets will be established depending on condom availability and community need. In collaboration with the District Directorate of Health Services, other district departments (education, fisheries and community development) and local fishing groups, the program will use a variety of communication channels to reach communities, including music, dance and drama; and community meetings. Working with local community groups, the program will support the set-up and/or strengthening of community-based support groups and post-test clubs to assist in providing psychosocial support to persons who have accessed HIV testing. Support supervision and monitoring of HIV prevention team will be enabled by program management to ensure realization of outputs and assessment of the quality of services provided to the beneficiaries.

In FY 2013, Kalangala District Local Government (KDLG) will facilitate the implementation of PMTCT Option B+ activities in eight PMTCT sites in Kalangala district.

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 by ensuring 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 and Health Center (HC) IVs and six HC III levels. Activities will include site assessments for accreditation; identification of training needs; procurement of equipment; printing M&E tools, job aides, Option B+ guidelines, training of service providers and sample referral system for CD4+ and Early Infant Diagnosis (EID). The transition of Option B+ in KDLG sites will be done in accordance with MoH guidance and a total of eight sites will be accredited by end of FY 2013. KDLG will support the delivery of Option B+ services using a family focused model within MNCH settings in which, family support groups will be formed at all PMTCT sites; will meet monthly to receive adherence counseling and psycho-social support, Infant and Young Child Feeding (IYCF) counseling, EID, family planning counseling, couples HTC, supported disclosure and ARV refills. Village Health Teams (VHT) 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 VMMC.

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 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 clients who are lost to follow-up.

4) Facilitating quarterly joint support supervision and 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 (FP) services with PMTCT service to ensure FP sessions are integrated within PMTCT trainings, counseling; education, and information during ANC, labor and delivery, and postnatal periods, as well as, for women in care and treatment; based on respect; womens choices; and fulfillment of their reproductive health rights.

KDLG will provide HIV counseling and testing to 2,623 pregnant women in 11 service outlets during FY 2013. A total of 525 HIV positive pregnant women will be identified, of whom 425 will be initiated on HAART for life (Option B+) and 75 will be provided with ARV prophylaxis (Option A); in addition, 485 exposed babies will receive ARV prophylaxis and DNA/PCR tests.

Kalangala District, in Central Uganda is comprised of 84 Islands in Lake Victoria of which 64 to 76 are permanently habited due to fish migratory patterns. Kalangalas unique geographical location has resulted in limited health and human services to this marginalized population of 36,661 (2002 Census) and projected population of 100,000 people. The district is served by only eleven health units: two Health Centre (HC) IVs, six HC IIIs and three HC IIs and no hospital within the district. Referrals for complicated health problems are made to mainland Entebbe, Kitovu, and Masaka Regional Referral Hospitals which is 80 kilometers from the main island. The secondary analysis of the USHBS central region data indicate that Kalangala District, has a prevalence of 27% approximately five times the national average, thus this population of fishermen and their families have been identified as a very-high risk group.

In FY 2011 we worked with Medical Access team that provided support for buffer ARV drug forecasting, procurement and supply to KHBVCT programme and was expected to promptly respond in case of stock outs. However during the period, MoH supported sites such as Kalangala HCIV and Bukasa HCIV that the program supports reported a stock out that was resolved by SUSTAIN at the beginning of the reporting period project and since the transition to KHBVCT we have not reported any stock outs. Now with the ARV supply chain rationalization, support from Medical Access will not count and Kalangalas public facilities will be getting their ARV drugs from National Medical Stores. The drugs are ordered every two months and the program gets them through a pull system. The program will continue to support health workers in making timely ARV forecasts to the National Medical Stores (NMS).

With FY 2012 funds, we shall procure buffer stock of ARVs (first and second line) to respond to periods of stock outs when need arises and continue to support health workers in timely ARV forecasts. Antiretroviral for Post-Exposure Prophylaxis will be made available for rape victims and other accidental exposures in addition to sensitization on availability of PEP drugs.

Kalangala district is served by only eleven health units: two Health Centre (HC) IVs, six HC IIIs and three HC IIs and no hospital within the district. Referrals for complicated health problems are made to mainland Entebbe, Kitovu, and Masaka Regional Referral Hospitals which is 80 kilometers from the main island.

In FY 2011, Kalangala HBVCT supported scale- up of adult care and treatment services in order to provide more palliative care services through support for monthly ART treatment outreaches up to 8 health centres located deep in the islands of Kalangala District and adherence follow up for clients on ART. By reporting period, 930 clients were served during ART outreaches. The minimum package of care services included but not limited to treatment and prevention of opportunistic infections including provision of cotrimoxazole prophylaxis. Follow up remains a challenge given the water barrier between landing sites and linkage/referral points, however, the programme has embarked on the use of peers on ground to assist in strengthening follow ups in the hard to reach areas.

In FY 2012, the program will enroll 700 new patients (441females; 259 males) on ART of which 75% are aged 15 years and above. The program will enhance clinical and laboratory monitoring of patients on Pre- ART or ART through support for management of opportunistic infections, CD4 counts, and related laboratory services at Kalangala HCIV, Bukasa H CIV, and Bukulula HCIV in addition to support for treatment adherence. In order to enhance HIV/AIDS care and management, we shall coach and mentor 30 health workers in overall HIV treatment to equip them with knowledge and skills to comprehensively manage HIV/AIDS. The service providers will also be trained in palliative care principles, care linkages/referral and dealing with HIV positive clients (diagnosed or presumed). This is very important in as far as quality of service provision is concerned.

Maintenance of the CD4 machine by KHBVCT program and procurement of laboratory reagents will continue in order to achieve onsite CD4 counts at Kalangala HCIV. In collaboration with the ART clinic in-charges, the program will provide support supervision and monitoring of interventions provided to ensure quality service provision. Collaborative linkages will be maintained with health units in the mainland, including Kalisiizo hospital, Bukulula health centre IV, Kakuuto health centre IV, Masaka and Kitovu Hospitals, for more specialized care. The program will continue to implement a referral system for HIV positive individuals for care and support with a view to reduce stigma towards HIV, reduce chances of transmission, and improve the quality of life of PHAs. Cotrimoxazole/ Dapsone prophylaxis will be provided along with care for opportunistic infections (OI). The programme will procure buffer supplies of ARVs for targeted Health centre IVs to back up the inadequate supplies from Ministry of Health. Information products based on data are translated into strategic information which is fed back to various stakeholders such as Ministry of Health through the district HMIS. The program also adheres to PEPFAR reporting systems (MEEPP)

In FY 2011, Kalangala HBVCT supported scale- up of paediatric care and treatment services in order to provide more palliative care services through support for ART treatment outreaches and adherence follow up for HIV exposed infants, children and adolescents on ART. Given the peculiarities of the district, Kalangala district was given first priority for this intervention in an effort to contribute to comprehensive HIV/AIDS care and treatment services. ART teams at Kalangala Health Centre IV and Bukasa Health Centre IV were able to conduct monthly ART treatment outreaches and adherence follow ups to 8 health centres located deep in the islands of Kalangala District.

In a bid to improve on pediatric HIV/AIDS treatment services health workers will be facilitated to conduct Early Infant Diagnosis (EID) through collection of DBS samples from children during immunization outreaches as well as support for follow up on HIV+ mothers who are delivered at the health units or elsewhere and be able to collect DBS samples for HIV PCR and ELISA testing using FY 2012 funds. In Kalangala district, collecting of DBS samples for pediatrics will be centralized at Kalangala HCIV for onward submission to CDC reference laboratory and MildMay Uganda for PCR to enable early infant diagnosis. These children will then be given cotrimoxazole syrups and followed up until they are able to access comprehensive HIV/AIDS treatment.

The program will enroll 175 HIV positive infants, children and adolescents with advanced HIV infection on ART; 11 will be under 1 year, 33 between ages 1-4 years and 131 between 5-14 years using updated national pediatric treatment guidelines and will ensure un interrupted supply of ARVs by providing a buffer stock in periods of crisis. We also plan to coach and mentor 30 health workers in pediatric treatment. Once a pregnant woman tests HIV positive in the Antenatal Care clinic, we shall encourage them to deliver from health units and link them up to PMTCT services. In order to enhance care and support to children infected by HIV, we shall assist in strengthening linkages of HIV exposed infants, HIV infected children and adolescents to access ARV drugs and treatment services which include: PHDP interventions, support groups, nutrition assessment and related interventions where appropriate, CD4 counts, giving out test results ensure enrolment into comprehensive HIV/AIDS care. Laboratory and clinical monitoring of children and adolescents on Pre- ART or ART will be supported at targeted health units in addition to support for treatment adherence. Collaborative linkages will be maintained with health units in the mainland, including Kalisiizo hospital, Bukulula health centre IV, Masaka and Kitovu Hospitals, for more specialized care. The program will continue to maintain linkages for HIV positive individuals for care and support geared to reduce stigma towards HIV and improve the quality of life of HIV positive children. Cotrimoxazole syrup for prophylaxis will continue to be provided along with care for opportunistic infections (OI) and the procuring of buffer supplies of ARVs (Pediatric formulations) for targeted Health centre IVs to back up the inadequate supplies from Ministry of Health. Support supervision will be provided to health workers to ensure proper documentation, report compilation and evaluation of the quality of care provided where appropriate.