The goal of the project Strengthening HIV Prevention, Care and Treatment among Prisoners and prison staff is to improve the health status of prisoners, staff and their families by strengthening the capacity of UPS to provide comprehensive prevention, treatment, care, and support services for HIV/AIDS & related OIs, STDs, TB & malaria - equivalent in the community & consistent with national polices within 5 years, objectives are: Document HIV/STD/TB prevalence, incidence and the related risky behaviors among prisoners and staff to inform health planning and services delivery in the UPS by 2010; Promote HIV prevention strategies for the prisons community; Provide comprehensive HIV/STD/TB continuum of care including HCT, clinical care, social support to 16875 prisoners, 2605 staff and 4704 family members by 2013; Develop and strengthen HIV/AIDS policies, operational guidelines & administrative instructions for the UPS by 2013. Activities for FY12 are capacity building trainings for health providers in HIV care with reference to HIV/TB Co-management; HIV counselors from among health providers; peer counseling assistants from among prisoners & M&E focal persons; provision of HCT; passing on of HIV prevention messages to reduce risky behaviors; development of customized peer based educational materials for prisoners to prevent HIV infection; establishment of posttest clubs; support for nutrition supplementation projects; treatment for HIV related infections; establishment of country wide post release referral networks for specialized care; development of SOPs/policies & strengthening the surveillance, M&E framework for HIV care and support for collection of PEPFAR indicator data. 2 vehicles were purchased and none for FY2012.

Target population includes prisoners, prison staff and their families. The Demographic characteristics of this population include majority age 18 years and above, both women and men residing within the prison wards and / or the prison barracks. Coverage is at national- level in reference to geographic area; particularly at the 11 regional prison units located across the country and support the lower prison units within the geographic loacation.

2. Provision of supportive counseling to HIV positive prisoners will very critical in prison settings. UPS will provide prison customized supportive counseling to prisoners PLHIV. This will provide a platform for improved quality of life and making informed decisions for positive live despite the incarceration status. This will be conducted at high HIV burden prison facilities in Northern and Kampala extra prison facilities. Counseling will partly be conducted through post test clubs and trained prisoner peer educators drawn from among the prisoners themselves.

Target population includes prisoners, prison staff and their families. Demographic information is stated in section 4 under overview narrative. Coverage is at national- level in reference to geographic area.

2. Under this program area, the IP focuses on adults and children receiving at least one clinical service and/or cotrimoxazole prophylaxis. In the FY 2012 it is targeted that at least 4,000 adults and children should receive at least one clinical service and 1,460 should be able to access cotrimoxazole prophylaxis; 115 HIV positive clinically malnourished clients should have access to supplementary food and/or be given food security; 1460 HIV positive patients should be screened for TB and the capacity to do this is available. UPS trained 144 health providers in TB/HIV co management in the FY 2011. It is estimated that in the FY 2012, 146 HIV positive clients will be started on TB treatment and 50 HIV positive women will ne newly enrolled in HIV care and support.

3. This is an activity that is part of routine clinic duties of health facilities of the Prisons Health Service. The IP receives TB drugs from the National TB and Leprosy Program-Ministry of Health.

5. With funds received from Global Fund, UPS intends to hold six capacity building trainings which are mainly clinical oriented to improve STI management.

6. Leveraging other funding could increase the quality of TB programs and enable scale-up

Target population includes children born to mothers under incarceration, female prison staff and female members of prison staff families. Coverage will be limited to prison units with trained counselors and midwives and these currently include the 11 regional prison units and a few in the regional catchment area.

2. There are children born by mothers under incarceration; women come into prison when they are pregnant and deliver in prison. The women prisoner population is lower compared to the male prison population however the children born by mothers in incarceration need care and support. According to the Prisons Act, babies are allowed to stay with their mothers in prison up to the age of 18months; then they can be taken to the family of the mother by prison social workers. Given the diet in prisons of only maize flour and beans, support for the children will include nutrition as well as child counseling on recommended positive living information for the mothers and the children.

Target population could include prisoners, prison staff and members of staff families. Demographic information is stated in section 4 under overview narrative. Coverage is at national- level in reference to geographic area.

2. Under this activity, support is aimed at improving access to CD4 testing, bio-chemistry and TB diagnostics. The activities will also support the establishment of laboratories at regional prisons to improve access to laboratory services by prisons in the region.

Target population includes prisoners, prison staff and their families. The Demographic characteristics of this population include majority age 18 years and above, both women and men residing within the prison wards and / or the prison barracks. Coverage is at national- level in reference to geographic area; but in particular to the 11 regional prison units with functional M$E and HMIS systems and all prison units sampled for the sero-behavioral survey.

2. UPS has been steadily working towards developing an electronic M & E system. UPS will procure computers to be stationed at 5 regional prison units (; these computers will be installed with a management information system to aid the electronic tracking, monitoring and use of strategic information. The information system will enable timely and safe transmission of data from all remotely situated prisons across the country to a central processing system at the prison project office. This will also serve the MOH national data health systems requirements.

Furthermore UPS will implement the Sero behavioral survey in FY 2012, qualified and experienced researchers will be recruited to implement the survey activities which are robust and complex.

In addition a sero behavioral surveillance system will be established within the prisons; this will cover all the 11 regional prisons across the country.

Capacity building will continue to take center stage with on job hands on training of health care providers, information management staff at all levels including custodian and non- custodian staff in recording, managing, reporting and dispersing data.

1. Target population includes prisoners, prison staff and their families. Demographic information is stated in section 4 under overview narrative. Coverage is at national- level in reference to geographic area. The HIV prevalence among prisoners according to a Rapid Situation Assessment conducted in 2008 with funding from UNODC is 11.2%. Among prison staff and their families, it is estimated to be at 6.4% as per the National statistics.

2. Under this program area, the IP in the FY 2012 will be conducting static HCT clinics at 13 sites (Regional prison units) and outreach HCT clinics at 16 outreach sites (local prisons). During FY2011 a total of 5,917 persons were counseled, tested and received their results; of these 4,693 were males and 1,116 females. A new activity in the FY 2012 is the training and involvement of prisoner peer counseling assistants in the provision of HCT services; this will scale up the number of persons reached with counseling and testing services, especially among the prisoners. The approaches used by the IP to offer counseling and testing are both client initiated and provider initiated.

3. HCT services are carried out as part of routine health care service delivery at the static clinics and are thus integrated into the mainstream of health care delivery. This strategy was put in place to avoid missed opportunities; at any one time a client should be able to have access to the service. However, in addition there are designated weekly HCT clinic days at the static sites. The concept of HIV/TB co-management is practiced in prisons and the target is for each person tested for HIV to be tested for TB and vice-versa. Knowing their HIV status, clients are referred for care and treatment programs accordingly; in the FY 2011, actual number of clients referred for care and treatment could not be determined due to the manual nature of data collection and storage. This is being rectified in the FY2012 and this data will be captured.

4. The UPS as a government based IP adheres and implements its programs in line with the National policies and guidelines as well as the M&E system provided by the Ministry of Health and Uganda AIDS Commission. The National testing algorithm is applied by the IP in the provision of HCT services.

5. During the FY 2011, a total of 144 health providers have had their capacity built in HIV care through trainings. In the FY 2012, 80 health providers will be trained in HIV care, 50 health providers will be trained as HIV counselors and 130 prisoners as peer counseling assistants and 20 staff will be trained in M&E.

1. Target population includes prisoners, prison staff and their families. Demographic information is stated in section 4 under overview narrative. Coverage is at national- level in reference to geographic area. However, prisoners only access condoms on release; while in incarceration, they cannot access condoms because under the Laws of Uganda, Homosexuality is a crime and thus UPS cannot provide condoms to prisoners despite reports of MSM in prisons.

2. Under this program area, MARPS reached with HIV prevention interventions during the FY 2011 were 12,683 males and 1,387 females; a total of 14,070. This was in prison units located in eight districts. In the FY 2012 the IP will be increasing the number of condom distribution outlets from 63 to 126. It is targeting to reach 31,200 MARPS (29,640 males and 1,560 females) with HIV prevention interventions.

3. Giving of prevention messages or implementation of prevention interventions are part of routine prison/health activities. For example, all newly admitted prisoners during on entry medical screening are given a package of prevention messages by a health provider or a peer educator.

4. Data collection tools to support data collection will be printed and streamlined during the FY 2012.

Uganda Prison Service serves mothers from within the prison establishments (female prisoners, staff and their families and the outside community). PMTCT services are offered largely from the main referral hospital (Murchison bay prison national referral hospital) where exists both inpatient outpatient MCH services. Approximately 2400 pregnant women access MCH / PMTCT services at Murchison bay Hospital and the recently accredited Gulu prison antiretroviral center. Based on the new guidelines UPS will shift from option A to option B+. As part of the PMTCT activities UPS will re enforce the health education programs conducted at the MCH clinics that focus on HIV prevention, behavior change, and couple counseling and testing, partners of pregnant and lactating mothers will receive education on risk reduction. Educational and community mobilization programs will be extended to the barracks that house approximately 3000 people all together inclusive of staff and their families. It is planned that Family planning education services will be offered to all women (approximately 2400) who attend MCH services at the hospital. Other services will include routine pregnancy tests and screening for STIs.

All mothers (206) identified to be HIV positive at the facilities will be provided with option B+ antiretroviral therapy and an estimated 17 exposed infants will be provided with ARVs for prevention of HIV infection. Mothers who reside within the barracks and those from the surrounding areas whose residence address is available will be followed up pre and post natal to provide continued prevention support services.

Target population could include prisoners, prison staff and members of staff families. Demographic information is stated in section 4 under overview narrative. Coverage is at national- level in reference to geographic area. The IP accesses ARVs from Ministry of Health and available are 1st and 2nd line drugs; However, there is need for 3rd line drugs which the Ministry has not planned for.

Target population includes prisoners, prison staff and their families. The Demographic characteristics of this population include majority age 18 years and above, both women and men residing within the prison wards and / or the prison barracks. Coverage is limited to Murchison Bay Hospital and Gulu regional prison health unit

2. UPS will provide treatment support to adult prisoners infected with HIV at Murchison bay hospital and Gulu regional prison health unit which are Ministry of Health ART accredited centers. Services will include counseling on ART adherence and other HIV related issues. These two health facilities for the time being until 03 more regional health units (Jinja, Mbale and Mbarara) are accredited should provide adequate HIV treatment services and supervision of lower prison facilities; this will involve timely refills for patients on ART.

. Target population includes prisoners, prison staff and their families. Focus will largely be on infants born with HIV. Coverage will include babies born HIV+ to mothers who are female prisoners, prison staff or female members of prison staff families.

2. The service will largely be extended to women prisons with big numbers of HIV positive children. UPS will also provide refresher trainings to staff at the those prison sites to improve their knowledge and skills in managing pediatric HIV/AIDS. The trainings will cover topics on the new HIV prevention strategies like ART as a prevention strategy and PMTCT.