The projects goals are to: provide a comprehensive HIV prevention, care and treatment package linked to TB management, prevention of opportunistic infections and prevention and management of STIs; and develop adequate human resource capacity for HIV prevention, care and treatment.

The HIV prevention services are targeted for both HIV negative and positive people; provide confidential counseling and testing to family members of TASO registered clients; and provide ART to TASO clients; The program provides comprehensive HIV/AIDS services to HIV infected individuals and their family members and facilitates referral for services not available at TASO; continuously improve monitoring and evaluation capacity and strategic information utilization for HIV programming at all TASO units and build the capacity of health workers and volunteers to provide HIV prevention services, care and adherence support. Currently TASO is transitioning the outreach approach to health systems strengthening and using MOH data tools for reporting. The program will not procure new vehicles but will maintain the existing fleet. TASO will promote combination HIV prevention, accelerate HCT to utilize scientifically proven strategies with high impact in preventing HIV infection; PMTCT, SMC and ART adherence. Efficacy of these approaches will be enhanced by effective linkages to ensure access to these and retention in care. For COP 2012 TASO activities will be carried out on a low cost extension budget, catering for activities that are crucial for the patients health.

Counseling PLHIV, their families and caregivers is a key component of the package required to improve the quality of life of infected and affected persons. TASO will provide high quality counseling services as one of the key components of care, treatment and support services. Counseling will aim at empowering HIV infected and affected persons to make informed decisions that improve their quality of life. Counseling will be conducted at: TASO Centers, clients homes, community drug distribution points, outreach sites and Hospital wards. Counseling will be provided through one-on-one sessions, couple sessions and group sessions to address individual concerns, couple concerns and to provide general up-to-date information to clients respectively. Through counseling, Counselors will provide up-to-date information on HIV prevention, STI, FP, PMTCT, condom use, nutrition, cotrimoxazole prophylaxis, tuberculosis and importance of consuming and using safe water. Counseling will also sensitize clients to balance their PLHIV rights with responsibilities such as preventing further spread of HIV within their communities. The key outcome of counseling will be empowering PLHIV to exercise their human rights and to make informed choices and decisions.

TASO will provide medical services aimed at early diagnosis and treatment of opportunistic and common infections among clients. Medical teams will follow up clients at TASO Centres and communities including clients homes.

TASO will educate clients and community members on STIs, and STI prevention. All active clients will be screened for STI at least twice annually. Sexually active clients will be screened at every visit. Clients diagnosed with STI will be given treatment. Clients diagnosed with STI will also be counseled and supported towards having their sexual partners screened for and treated if diagnosed with STIs. Clients diagnosed with STI will also be counseled on the importance of preventing transmission and/or re-infection between them and their partners. Among others, clients will be educated on correct and consistent condom use and provided with condom supplies. TASO Centres will refer complicated cases for specialist attention. Home care teams will follow up clients on STI treatment. Teams will assess progress, provide counseling on STI treatment and related issues and develop follow-on plans where appropriate. TASO will update its interventions to respond to emerging needs.

Uganda is a high malaria endemic country. Malaria is the biggest cause of morbidity and mortality in Uganda. HIV+ persons need more aggressive treatment for malaria in order to minimize complications. All clients served by centres and their family members will be sensitized on malaria prevention. TASO will ensure that 100% of active clients and their children below 5 year are using LITNs. All clients presenting with malaria signs and symptoms will be treated or referred as appropriate. Community mobilization and training will include messages on Malaria prevention and treatment. TASO has targeted 15,915 adults for care and support services.

The key goal is to enhance access to comprehensive services to Orphans and Other Vulnerable Children (OVC) in line with the National Strategic Plan for OVC and in particular children affected by HIV/AIDS. TASO will reach OVC who are HIV + or have lost a parent to AIDS or are living in HIV/AIDS households and are vulnerable to HIV infection or its socio-economic effects. The OVC will include those in and out of school.

TASO will provide 4000 OVCs with 3 or more CPAs and 6,400 OVC with 1 or 2 CPAs. 1,850 OVC will benefit from the food security program in form of garden tools and seeds.

Psychosocial and medical support will be provided to children living with HIV and those assessed to benefit from these services. Therapeutic feeding will be provided for malnourished children initiating ART, anti-TB treatment or those living with HIV and are moderately malnourished; educational support will be given to children living in extreme poverty to enable them benefit from Government Universal Primary and Secondary education programs. All children will benefit from child protection and HIV prevention services. OVC households in need of services not offered by TASO OVC program will be assessed and referred to other agencies within the community network model. All strategies applied by TASO are aligned to the National OVC policy and the National Strategic Program Plan of Interventions (NSPPI) for OVC.

Successes include: building capacity of families to meet the needs of OVC, training care givers to support OVC, OVC have been able to consistently attend school and complete education at the three levels i.e. primary, secondary and tertiary. OVC have acquired vocational skills and become self sustaining, OVC have also been able to access services in more than 3 Core Program Areas (CPAs).

TASO closely works with respective district probation offices to identify target sub counties for the OVC programs.

High poverty levels have constrained the program and some care givers are unable to meet their obligations leading to poor academic performance of OVC.

All clients will be routinely screened for TB as well as family members, contacts of known TB cases or other community members presenting for HCT. There is adequate laboratory infrastructure to make rapid and accurate diagnosis of TB. TASO will screen over 100,000 clients at the 11 TASO centers and all supported public health facilities. It is estimated that TASO will treat 2000 confirmed TB cases. These will be counseled and treated according to the national Directly Observed Treatment Short course (DOTS) TB treatment guidelines. Follow up will be provided through clinic and home visits conducted by TASO staff, VHTs or other community volunteers. The major challenge will be reaching a diagnosis of TB in PLHIV in particular extra pulmonary TB especially in children.. Intensive case finding will be conducted by use of a standard TB screening tool, Use of GeneXpert technology once the care protocol is ready will be used. TASO will pursue high-quality DOTS expansion and enhancement by implementing case detection through quality-assured bacteriology using sputum smear microscopy and GeneXpert technology at TASO or other partner sites. National and Regional Reference Laboratories will be used for quality assurance. Standardized treatment, with supervision and patient support based on MOH guidelines will be applied making use of effective standardized, short-course regimens of fixed-dose drug combinations. Supervision will focus on both the health care providers and the patients. TASO will work with respective offices of the DHOs to ensure effective TB drug supply and management system including an M&E system that utilizes the national TB register as the primary data collection tool.

TASO will contribute to addressing the threat of Multi-Drug Resistant TB (MDR-TB) and other challenges through implementing collaborative TB/HIV activities including: collaboration with the National TB/Leprosy control program and Uganda Stop TB Partnership (USTP) of which TASO is a member, reducing the burden of TB in PLHIV through intensified case finding at all service points and their households members; referral between HIV and TB services; INH provision once the policy has been approved and ensuring infection control at health facilities and other congregate settings. TASO has implemented a TB infection control plan at all her facilities that includes administrative, environmental and personal protection measures.

TASO will contribute to Health System Strengthening by participating in improving system-wide policy by working with VHTs and developing their capacity to manage TB.

The program will scale up pediatric HIV care services in all the supported health service outlets including the public facilities by training health workers and utilizing the services of VHTs who are directly involved with the communities to encourage parents and care takers to bring in children who are known to have been exposed to HIV. This will increase the number of children receiving services in the facilities to 15,883.

Counselors will provide up-to-date information on HIV prevention with emphasis on safe infant feeding practices as recommended in the national guidelines, nutrition, cotrimoxazole prophylaxis, tuberculosis control and management and the importance of consuming and using safe water. Retention in care will be strengthened by use of VHTs, expert clients, community nurses and field officers. Adolescent health and reproductive issues will be supported and addressed at each service outlet by encouraging peer to peer group discussions. Children with OIs will be treated and complicated case will be referred. Cotrimoxazole prophylaxis will be provided to all children including exposed infants.

Parents and care takers will be sensitized on malaria prevention in children and the program will work with PACE (distributers of the Basic care package) to provide LLITNs to children under 5 years. All children presenting with malaria signs and symptoms will be tested and those diagnosed with malaria will be treated and those with severe malaria will be referred to hospitals for further management.

TASO laboratories meet PEPFAR II indicators for quality in laboratory services. Training of laboratory staff will continue and all staff will be certified in Good Clinical and Laboratory Practice (GCLP) in the first half of 2012.

TASO has 12 functioning laboratories. They have designated areas for testing, storage and archive facilities. The laboratories have necessary infrastructure, qualified personnel and equipment. TASO laboratories will access DNA PCR testing and Viral Load (VL) through support by the Central Public Health Laboratories (CPHL).

The laboratories will conduct tests including: HIV screening as per national testing algorithm, Hb estimation, Sputum microscopy for TB, VDRL (RPR) for syphilis screening, Blood smear for Malaria and other hemoparasites, CD4 testing to assess eligibility for starting and response to ART, Full blood count, ESR, Liver Function Tests (LFTs), Renal Function Tests (RFTs), Blood sugar, Lipid profile and pancreatic profile tests as investigations used in monitoring of HIV patients on ART , Gram stain for bacterial infection especially gonococcal, stool microscopy for detection of intestinal parasites, urinalysis to detect Urinary Tract Infections (UTIs), skin scrapings to detect fungal elements, Cryptococcal Antigen (CRAG) test to diagnose Cryptococcal Meningitis, TOXO to diagnose Toxoplasmosis, and modified Ziehl Neelsen (ZN) to diagnose Cryptosporidium.

TASO has a Stores Information System (SIS) and Clinical Laboratory System (CLABS) linked to the TASO database. All purchases and utilization are tracked and SIS generates consumption reports and projections. CLABS generates reports to aid planning and forecasting.

TASO will strengthen laboratory services using the WHO strengthening laboratory management towards accreditaion approach and implementation of quality management systems.

For the targets on accreditation they can provide a realistic subset of their numbers reaching national accreditation levels using the WHO checklist.

TASO developed a user friendly computer based Management Information Systems (MIS) for tracking and generating Strategic Information. Key systems in use include Navision 3.0, accounting systems, Health Management Information Systems, appointment management system, client identification/mapping system, clinical laboratory information system, pharmacy and stores information management systems, supply chain management information management systems, fleet management system and Human resource information system. These systems are integrated in order to maximize the quality and integrity of information produced. During FY 2012, the systems will be updated and aligned to the MOH monitoring and evaluation system. TASO monitoring and evaluation activities will continue to complement the national data systems and will work towards alignment with the one national Monitoring and Evaluation system. TASOs national contribution is to ensure that quality services are provided to PLHIV through use of national guidelines.

Support supervision activities will be conducted jointly with technical teams from stakeholders including MOH officials, district officials, TASO support teams, and development partners technical teams. Periodic program reviews will be conducted TASO plans to roll out the Lot Quality Assurance Sampling technique with support from STAR-E; project, to continuously measure outcomes and impact of our services at community level. The Performance Monitoring Plan will be reviewed to take care of the adjustments in programming. TASO will gather feedback from clients on the quality of service delivered through client satisfaction interviews conducted bi-annually at the 11 sites. TASO has built strong HIV quality improvement teams at centres to monitor various indicators. Each centre has a quality improvement team that oversees implementation of quality improvement projects in selected service delivery areas and indicators.

In March 2010, the Ministry of Health (MoH) launched the Safe Male Circumcision policy to guide the integration of Voluntary Medical Male Circumcision (VMMC) services in Ugandas national health system to reduce the number of new HIV infections. This followed a WHO recommendation that male circumcision be considered as part of a comprehensive HIV prevention package (based on the clinical trial conducted in Uganda, Kenya and South Africa).

From the modeling conducted in Uganda, it was shown that scaling up VMMC would result in averting 428,000 adult HIV infections from 2009 to 2015. In order to achieve this impact approximately 4,200,000 circumcisions would be performed by 2014/2015.

Given the results of the UAIS (2010/2011) with alarming increase in HIV prevalence and very low circumcision prevalence (26%), PEPFAR Uganda has prioritized this prevention intervention as a major pivot to reduce the number of new HIV infections.

VMMC is being offered in Uganda as part of a comprehensive HIV prevention package, which includes: promoting delay of sexual debut (for primary abstinence), abstinence and reduction in the number of sexual partners and being faithful, providing and promoting correct and consistent use of male condoms, providing HIV testing and counseling services and referral to appropriate care and treatment if necessary, and providing services for the treatment of sexually transmitted infections. The VMMC program offers a unique opportunity for men who are identified as HIV positive to start care and it engages female partners to advocate, mobilize men and involve women in seeking HIV Testing and Counseling (HTC) with appropriate referrals, including ANC and PMTCT care.

TASO will accelerate the scale-up of VMMC and will prioritize areas with high HIV prevalence among women and low circumcision rates in men in.

TASO will use the Model for Optimizing the Volume for Efficiency (MOVE) as a menu to increase the number of men for VMMC. Multiple delivery approaches to ensure safe scale up of services will be used including dedicated VMMC teams providing integrated services within 19 health facilities: hospitals, health centers and roving teams conducting seasonal outreaches in targeted districts with high HIV prevalence among women and low circumcision rates in landing sites along lake Victoria in Wakiso district. In total TASO will circumcise 38,397 men in FY 2013.

Creating acceptance and demand for VMMC should be generated through a series of community campaigns based on information from WHO, UNAIDS and the Uganda National Communication Strategy on Safe Male Circumcision. In FY 2013, TASO will employ both media campaigns and person to person message packaging to target men (and female partners to increase testing uptake. TASO will provide daily reports to the SMC National Operational Center as required by MOH.

TASO will pay special focus on quality assurance and quality assessments will be conducted on a regular basis and will liaise with Medical Access Uganda Limited (MAUL) for provision of VMMC kits.

The projects VMMC interventions in Uganda are geared towards contributing to goal one of Uganda National HIV/AIDS Strategic Plan To reduce the incidence rate of HIV by 40% by the year 2012 and objective 5 To promote use of new prevention technologies and approaches proven to be effective.

HCT is an entry point to HIV prevention, care, and treatment services. Knowledge of HIV sero status is a pre-requisite for access to effective HIV interventions that reduce morbidity, mortality and HIV incidence. TASO provides HCT to family members of clients. TASO also provides re-testing opportunities for those in discordant relationships. Last year TASO reached out to 13,466 people with VCT and HBHCT using home visits and outreach model. Of this number, 542 were children under 5 years, 2,860 young people aged 5 -17 years and 10,064 adults aged 18 and above; 776 couples were reached with HCT and risk reduction messages in various communities. Prevalence of HIV in this population is similar to the national average of 6.4%.

TASO has been able to reach out to MARPs with HCT services during special events including center annual meetings, candle light days, Every Body Wins campaigns and on international AIDS day. Populations reached include fisher folks, uniformed services, youth and prisoners. All people that tested positive were linked to care through referral to TASO or their preferred choice of facility.

In FY12, TASO intends to strengthen efforts at providing HCT services to 30,000 individuals; 900 shall be children less than 5 years, 3,000 shall be aged 5-17 and 26,100 adults aged 18 and above. The services will be offered at all TASO centers and surrounding districts. VCT will target couples and MARPs with specific focus on Commercial Sex Workers (CSWs), uniformed services, fisher folks and prisoners. TASO will ensure delivery of combination HIV prevention to all populations reached using National guidelines. The combination will include ART, PMTCT and safe male circumcision in addition to others i.e., BCC, Condom promotion, VCT and HBHCT. The sensitization component will be delivered through small group focus discussions, dialogue meetings and one-on-one sessions. TASO drama groups through Music Dance and Drama skits will mobilize communities for HCT services. Those that test positive will be linked to care and support services either to TASO or other service providers of preference. In addition linkages will be made with other partners that offer services for SMC, STI management and other services to ensure an effective referral system. TASO will follow up those that have been referred to ensure they access the service they require.

TASO centers serve clients from the host district and up to 5 neighboring districts. Over 554 pregnant clients accessed ART for PMTCT at TASO in FY11. The new PMTCT guidelines were changed and TASO will shift to Option B plus as recommended by Ministry of health. TASO will implement the 4 pronged strategies namely: prevention of HIV infection among women and the girl child; prevention of unwanted pregnancies among women living with HIV/AIDS; prevention of HIV transmission from infected mother to the unborn baby and offering care and support to the mother, infant and family.

TASO will conduct community mobilization and sensitization to create awareness on HIV prevention and carry out behavioral change communication to keep HIV negative pregnant & lactating women to remain HIV negative. All pregnant & lactating women and their partners attending ANC clinics will be tested for HIV and receive same day results. TASO will also facilitate referral and linkages for safe male circumcision, support disclosure of HIV sero-status to partners, partner testing, community mobilization and empowerment, STI screening and treatment and promote an enabling environment for gender equity.

Girls will be reached at schools and for out-of-school girls; through community mobilization, youth clubs and groups. Females testing HIV positive will be actively followed up to link and retain them in HIV care, support and treatment services.

TASO piloted integration of Family Planning (FP) into HIV/AIDS care. Lessons learnt will inform scale up of FP services and male involvement. Over 10,000 women will access modern FP methods. TASO will conduct condom education and distribute 1,000,000 male condoms; emphasis will be on correct and consistent use. Female condoms will be promoted and distributed once available.

TASO will implement early identification of pregnant clients through routine HCG testing, screen for STIs at every interface with a provider and treat those infected with their partners. Client will get CD4 screening and provision of ARVs for prophylaxis or treatment basing on the national guidelines. Mothers will be followed both at facility and at home to assess clinical well being, adherence to treatment, psychosocial environment and to support them with their spouses to develop a birth preparedness plan. They will be given information on FP before delivery so that they make their choices early enough to avoid future unwanted pregnancies.

To ensure continuity of care and support, households will be involved; including education of family members about HIV/AIDS, identification of medicine companions and spouses will be educated on involvement in PMTCT activities. Expert mothers with previous PMTCT experience will be part of the community resource to educate others about the benefits of PMTCT. They will do follow up of mothers within their locality and link them to health units.

TASO will provide ART in line with MOH national treatment guideline. Drug procurements will take care of the 55,580 clients planned to be on ART by end of FY 2012. ARVs will be procured centrally using appropriate MOH tools basing on consumption data and forecasts. ARVs will be distributed to the 11 service centers using a pull system. The public health facilities that TASO supports will be given technical assistance to plan and forecast their ART needs and then place orders at the national medical stores (NMS). Strict ARVs pipeline tracking will be observed to check against waste, pilferage and inefficiencies at every stage including consistently appending a patients finger print or signature as needed. A minimum of 2 months buffer stock will be maintained to ensure reliable supplies throughout the supply cycle. Paper and electronic information management systems will help in tracking and accounting for products. Multi-disciplinary medicines and therapeutic committees will regularly review the essential medicines list in order to promote safe and rational use of medicines as well as strengthen collective responsibility among prescribers, management and pharmacists. CMEs, mentorships, technical support, training will be undertaken to equip the staff with new knowledge and skills.

TASO will continue supporting 50,021 adults on ART at all the service sites. It will provide counselling on ART adherence and other HIV related issues. ARV services will be provided at TASO facilities and in the communities; 70% of the clients receive their refills from their communities or homes while the remaining 30% get their refills from the facilities. Focus will be on staffing, logistics, human capacity development, implementation, information systems, community involvement and strengthening partnerships. TASO will collaborate with other partners involved in the provision of the continuum of care and in particular will support development of capacity of partner public health units to provide ART, CD4 monitoring for all pre-ART and ART clients every 6 months, viral loads will be supported when indicated. Staff will deliver ARV drugs in the community closer to clients homes and provide ART adherence counseling to clients. The community based approach is necessary to ensure adequate drug adherence to prevent emergence of HIV drug resistance as most of our clients are rural based and too poor to regularly collect their medication from the facilities which are often distances away.

Using guidelines provided to them, field staff will be able to report back to the clinicians the progress of the clients in the community.

TASO will increase the proportion of pediatric patients on ART from the current 7% to 10% by the end of FY2012 and will provide refresher trainings to staff at the different sites to improve their knowledge and skills in managing pediatric HIV/AIDS. These trainings will include provision of knowledge on the new HIV prevention strategies like ART as a prevention strategy and PMTCT with the overall objective of ensuring that the staffs provide appropriate messages and interventions to children and parents/guardians. Continuous medical education sessions will be held to update staff in the area of pediatric HIV/AIDS services.

TASO will build the capacity of 23 MOH sites in pediatric HIV/AIDS treatment through training and mentorship. They will work with VHTs and support them to map out the children on ART, provide information on the importance improved quality of life through routine clinical and laboratory monitoring.

TASO will support the 23 MOH sites to do Early Infant Diagnosis (EID) and will offer staff refresher trainings, initially linking these public health sites to (DNA PCR) providers, transporting samples to hubs, timely delivery of results to service sites and supporting timely feedback on results to children and/or parents/guardians. Later TASO will support set up EID care points and harmonize them with immunization, RH/FP clinics in order to make the sites a one stop shop for the mother-baby pair.

All children will receive 6-monthly CD4 monitoring (both pre-ART and ART). Viral Load monitoring will be done on case-by-case basis as assessed by staff. Child-friendly services will be provided at all TASO sites. TASO will provide MOH guidelines and also support discussions of these guidelines in Continuing Medical Education (CME) sessions, and meetings. Supervisors will ensure adherence to guidelines through sit-in-sessions, chart reviews, support visits, distribution and access to the guidelines.