The Kiboga-Kibaale Project (KKP) began implementation of activities in October 2008 following a cooperative agreement award from CDC to the Infectious Diseases Institute. The main purpose of the project was to strengthen HIV/AIDS service delivery in government health facilities of underserved and hard-to-reach communities of Kiboga, Kibaale and later Kyankwanzi, Hoima, Masindi and Bulisa. Currently technical areas of focus include: HTC, Care and treatment including TB/HIV coinfection management, strengthening PMTCT and EID and Pediatric Care. To date, HIV prevention, care and treatment services have been scaled up to 26 health facilities across the 6 supported districts.

EKKP implementation approach emphasizes health systems strengthening: strengthening human resource technical capacity; improving logistics management systems to reduce stock outs; strengthening management of health information; improving district leadership and management capacity to ensure a sustainable HIV/AIDS response; strengthening community structures to support HIV/AIDS service delivery; and building the capacity of district laboratories.

In FY 2012, EKKP will extend support to 2 hospitals, 9 health centre IVs, 72 health centre IIIs and 6 health centre IIs. The project will build capacity for ART accreditation at an additional 9 sites. EKKP will scale up PMTCT services to cover all health centre IIIs in the 6 districts and health centre IIs in Bulisa. This will be done through sub-granting to the districts, training, mentorship and technical assistance to ensure district ownership and training District Health in M&E and supporting them to develop M&E plans that feed into national information systems. No plans to purchase vehicles with FY2012 funds.

During the first half of FY 2011, the project provided support to 12 ART accredited sites. These health facilities provided at least one clinical service to 13,535 clients attaining 74% of set target for the year (18,564) and 24% of the estimated number of People Living with HIV/AIDS (PLHIV) in the region.

During FY2012, EKKP will facilitate the enrolment of 5,148 clients into care and 2,784 clients on ART bringing the total number of clients to be served during the year to 20,526 (36% of the estimated number of PLHIV).

During FY12, the project will focus on supporting the districts to have 9 additional health facilities accredited to provide HIV/AIDS care and treatment services while maintaining the capacity of the existing 11 facilities. ARV services, management of opportunistic infections, TB/HIV co-infection management, and other services will be strengthened. Technical Assistance to target facilities will be provided through continuous mentorship and support supervision. EKKP shall continue facilitating Integrated Static Outreaches to extend provision of HIV prevention, care and treatment services at health facilities not accredited to provide ART while building their capacity towards attaining accreditation to provide ART services. Health facilities will also be supported to strengthen the tracking of patients who miss appointments or are lost to follow up. The project shall also continue supporting the formation and regular meeting of PLHIV support groups in district hospitals. These will be continuously provided with counselling to prevent further transmission of the Virus, management of opportunistic infections and adherence to drugs.

During Integrated Static Outreaches (ISOs), immunization and family planning to both HIV positive clients shall be integrated. Information about reproductive health, malaria control, among others will be provided during sensitization activities. Pre-ART clients will continue to receive co-trimoxazole, basic care kits and a blood test every six months as per national guidelines and those found ART eligible will be enrolled on ART. These clients will continue to be given prevention messages and counselling on positive living. Positive Prevention will be implemented as an integral part of general HIV care and treatment. Service providers will provide routine HIV counselling to PLHIV. This will be aimed at minimising behaviours that could lead to further transmission of the HIV virus.

The project shall develop networks with other partners who are involved in provision of nutrition services to enable access to food support for the clients supported. This is aimed at supplementing the medical care provided at the health facilities and also contributing to boosting immunity against opportunistic infections. The coordination and leveraging of resources shall be achieved through the stakeholders, planning and DHAC meetings chaired by the district and supported by the project.

In conclusion, the project will continue to scale up care and treatment services in line with the second goal of the National HIV/AIDS strategic plan i.e. To improve the quality of life of PHA by mitigating the health effects of HIV/AIDS by 2012.

In FY 2012, EKKP will continue to support host districts to strengthen TB/HIV integration activities across 89 health facilities in the six districts. The objectives of the support will be to support recipient districts 1) improve TB screening for HIV-positive individuals; 2) provide HIV testing to all TB patients and 3) improve care and treatment for TB/HIV co-infected individuals.

The project will continue to support a combination of facility and community based approaches to strengthen TB/HIV services. The project will support the screening of all HIV positive persons for TB (cumulative) and provide TB/HIV integrated care to all determined individuals to be TB-HIV co-infected. To ensure sustainability of services, EKKP will continue to support the improvement of existing structures and systems within the health facilities by working with and strengthening staff capacity to deliver the services.

TB Screening and diagnosis

All identified HIV-infected individuals will be screened for TB. This will be done using history, laboratory screening and chest X-ray methods. All TB suspects will be promptly identified and separated. These will also be given infection control equipment and immediately started on TB treatment and continuously followed up with support from the AIDS Community Volunteers (ACVs). Clients in waiting area will be educated more about TB symptoms and encouraged to seek for treatment early. The adequate ventilation brought about by the renovated waiting areas across health facilities will enable better control of infection.

In cases where HIV infected individuals are identified at HCT outreaches, TB screening will be conducted and appropriate referrals will be made to the health facilities that have TB diagnostic capacity. For communities where these facilities are distant, the project will support the establishment of sputum referral mechanisms to ensure timely TB diagnosis and follow-up of clients.

The program will provide support for a communication campaigns aimed at increasing awareness about knowledge of HIV status, TB symptoms, TB-DOTS and ART literacy in target health facilities and the surrounding communities.

On-going technical support will be provided to all the laboratories capable of TB sputum examination including supporting florescence microscopy diagnostic techniques in district hospitals.

TB Treatment

The project will support the districts and the facilities to improve the services provided at TB clinics and strengthen the use of SOPs to enhance quality service provision, to ensure optimal client retention and treatment completion. District Health Offices will be supported to ensure a constant supply of TB drugs, cotrimoxazole and ARVs to TB/HIV co-infected patients.

Health facilities will target to provide HCT to 100% of new TB clients and treatment for TB and HIV for all TB/HIV co-infected cases. This will be achieved through mentorship of health workers, supporting CMEs in TB HIV co-infection management, community sensitization and follow up activities with the aid of VHTs and PLHIVs. HCWs will be supported to implement TB infection control and disease prevention activities according to the updated national TB guidelines.

During the first six months of the current financial year (FY2011), the project provided support towards pediatric care and support services across all the 12 ART accredited sites including one (Kigorobya HC IV) that newly acquired ART accreditation. These health facilities provided at least one clinical service to 1,143 children and adolescents representing 8% of the total number of clients served (92% represents the adult population) This is still below the national target, 13% of the entire population served to be children and adolescents.

During FY2012, EKKP will increase this percentage to 13% of clients given at least one clinical service. This will translate to approximately 2,668 children and adolescents. Child clients will be facilitated to access a comprehensive package of high quality pediatric care and treatment services. Pediatric care and treatment services to be offered shall include; early confirmation of HIV infection status; growth and development monitoring; immunizations according to the recommended national schedule; prophylaxis against opportunistic infections especially Pneumocystis Carinii Pneumonia (PCP); treatment of acute infections and other HIV-related conditions; counseling caretakers on optimal infant feeding, CD4 screening, ART , psychosocial support for the infected child, caregiver & family; and referral of the infected child for specialized care if necessary. Positive Prevention will also be integral component of the HIV counseling package provided to adolescents. This shall include; counseling on positive living, disclosure, abstinence, alcohol and drug abuse among areas.

All ART accredited sites will be provided with continuous mentorship, technical support and assistance in pediatric care and support. Support supervision will entail assessment of clinic infrastructure, training needs, staffing and other HR issues, logistics, transportation, children/client satisfaction, liaison with families and communities. Districts will be supported to use Village Health Teams (VHTs) in linking communities with health facilities and supporting client follow up, adherence on prophylaxis, appointments as well as tracing clients who are lost to follow up. HIV prevention, care and treatment shall also be integrated into other Maternal and Child Health activities implemented in the districts.

During provision of pediatric care and treatment services, services targeting other infants (apart from those targeted for HIV/AIDS services) will be provided e.g. immunization. Information about reproduction health, malaria control, and nutrition among others will be given freely to care takers during sensitization activities. Quality of care initiative like CD4 testing every six months for infants and adolescents shall be introduced. Also early infant diagnostic and care services shall be scaled up namely; DBS testing and provision of cotrimoxazole prophylaxis for exposed infants.

In conclusion, the project will continue to scale up pediatric care and treatment services reach out to more infants and improve the quality of life of infants and adolescents. This is largely in line with the second goal of the National HIV/AIDS strategic plan i.e. To improve the quality of life of PHA by mitigating the health effects of HIV/AIDS by 2012. All trainings conducted, policies and guidelines promoted are for the Ministry of Health.

Narrative not expected. Recieved money in pre-cop funding.

During FY2012, EKKP continued to facilitate activities aimed at strengthening collection, analysis and dissemination of information in the districts. These included; performing renovations to create space for storage for client files, electronic capture of patient care records, rewriting of registers and rearrangement of patient care files, training of in-charges, medical records clerks and biostatisticians in proper records and data management, transportation and distribution of data collection tools.

In the next financial year, the project shall continue to support the National Health Management Information System (HMIS) by working closely with the Resource Centre to facilitate the roll out of the revised HMIS data collection and reporting tools across project supported sites. This shall include the electronic District Health Information System (DHIS), a web-based system developed by CDC for the Ministry of Health to facilitate storage and quick retrieval of vital statistics for monitoring, evaluation and quality assurance. EKKP shall also continue to support the roll out of the Open MRS system for medical records management after completion of the pilot phase now left with 4 months. This will involve conducting onsite trainings for all health workers, installation of the software and facilitating entry of the backlog. Supervision and mentorship shall be stepped up to include data management CMEs, data harmonization meetings, internal data quality audits.

Based on the standards specified by the national laboratory technical working group, 18 laboratories will be targeted to have capacity and conditions to conduct the minimum clinical HIV related tests and 15 shall be accredited. The WHO/CDC laboratory strengthening checklist used in the SLMTA approach shall continue to be used to measure progress in laboratory performance towards attaining the different accreditation levels.

EKKP will focus on developing linkages with Health Centre IIIs, strengthening internal and external quality control programs, equipment management, procurement supply chain management, document control, client management and other elements of the LQMS and increasing the range of tests to cover most of the common diseases that cut across the Health System including support in establishing disease surveillance systems within the districts. Development of district laboratory networks will be consolidated and linkages with Central Public Health Laboratory further developed. The Project will continue to support CPHL/MOH to develop national guidelines and facilitate the implementation of the guidelines at facility level. Laboratory and blood transfusion services that support Maternal Health, Child Health and non-communicable diseases such as diabetes and hypertension will be developed down up to Health Centre IIIs. Didactic training, mentorship and support supervision will be used as the main tools for personal capacity development.

In FY2012, the project will support the districts to address accountability issues to enable better management of funds. The sub-granting mechanism will also be scaled up to all the six. IDI will also continue to interface with other IPs and CDC to share experiences and lessons on better approaches to support implementation through sub granting.

Narrative not expected. Recieved money in pre-cop funding.

Between October 2010 and March 2011, the project facilitated HCT across 26 sites reaching out to 76,924 people in the 6 districts and achieving 51% of the target for the financial year.

In FY 2012, the project will support HCT in 89 health facilities across the same 6 districts reaching 155,000 people through facility and community based approaches. Provider Initiated HCT (PICT) will be further strengthened targeting all eligible patients and caretakers eligible for testing accessing services from the outpatient and other departments at each health facility. HIV testing will be decentralized and monitored for quality control and assurance. Efforts will be made to document PICT integration across all the departments and linkages into care of those diagnosed with HIV infection.

Targeted community HCT activities will be facilitated monthly by the project in each district mainly targeting communities that have not been reached before. Special events will be conducted targeting Most At Risk Populations (MARPS) and other special groups including fisher folk, uniformed populations, couples, youth in schools, teachers and Boda-boda cyclists. Couple HCT will be scaled up through mentoring health workers to improve their skills in mobilisation and reaching out to couples. The teams shall refer men for Male Medical Circumcision services.

Internal and external controls, self-reflection, client interviews, and data collection using the national HCT tools will be strengthened. Each service provider will receive a Routine HIV Counselling and Testing (RCT) cue card and each facility a copy of the Standard Operating Procedures (SOPs) on HIV counselling and HIV testing, a copy of the HCT policy and implementation guidelines. In effort to strengthen linkage into care, clients will be guided and escorted to care and treatment units.

Buffer support will be maintained for HCT commodities and supplies including data collection tools, HIV test kits and test tubes to mitigate supply chain constraints.

As part of the strategy to boost the technical capacity of health workers to effectively provide HCT services, Health workers will be trained in counselling supervision and mentoring and facilitated with terms of references. The project will facilitate quarterly supportive supervision visits and mentorship.

Face lifting will also be done to improve the working environment and create more space for better privacy during counselling. Tents and chairs will be provided for community outreach activities.

Other health services will be improved as well including ANC attendance beyond the first visit, access to family planning, immunization, and care and treatment for malaria. Trainings conducted in HCT will boost knowledge and skills in counselling and management of other health conditions.

In FY 2011, IDI supported the start-up activities for a Multicounty Public Health Evaluation (PHE) dubbed STATUS Strengthening HIV test Access and Treatment Uptake Study. Primarily this PHE is meant to compare three models of HCT in OPDs to determine which model results in: higher percentage of eligible outpatients receiving an HIV test; higher percentage of HIV-infected persons identified in the OPD subsequently enrolled in HIV care and treatment services and most cost effective provision of HCT in the OPD. Support to STATUS will continue and will be completed in FY 2012.

During the semi-annual period for FY11, 17,836 mothers were counseled, tested and given results, 685 tested HIV positive, and up to 77% of these received ARVs for PMTCT. Three hundred and seven health workers were trained in new PMTCT EID guidelines in the six districts. The Districts PMTCT teams were given training skills by MoH trainers in a TOT course. MoH/ACP certified trainers provided the teams overall technical assistance during the district led trainings and mentorship exercise. The support package included printing of MoH recommended data collection tools and procurement and distribution of equipment such as Salter weighing scales, infantometers, Mid Upper Arm Circumference (MUAC) tapes, thermometers and tongue depressors. The District training teams with technical support from IDI and MoH will carry out mentorship on a quarterly basis to all Health facilities in a phased manner involving establishing PMTCT services in 2 Hospitals, 9 HCIVs and 59 HCIII, and 6 HCIIs. In FY 2012, the project shall continue using the 4-prong strategy of PMTCT intervention. Under prong 1, the project will support both facility and community based HCT services to 61,857 pregnant mothers, about 80% of all mothers expected ANC attendance. Prong 2: 3,235 of the HIV positive mothers will receive family planning information during the counseling sessions in health facilities and during immunization outreaches.

Prong 3: Efficacious ARVs for PMTCT will be provided to 100% of the HIV positive women after assessing and staging using either WHO or CD4 count. The estimated number of HIV positive mothers needing PMTCT drugs is 3,684, 60% of HIV+ mothers linked to care and treatment in 20 HIV ART sites. Twelve ART accredited sites will introduce Option B by the end of FY2012 with 1,505 mothers receiving HAART.

Prong 4 will involve integration of Dry Blood spot (DBS) collection for Early Infant Diagnosis (EID) on site in Post Natal Clinics and immunization outreaches. A Hub system will ensure 2,727 DBS samples are collected by all health facilities within a Health Sub District depositing samples to the HCIV or hospital. The project will then facilitate transport to the Central Public Health Laboratory in Kampala. DBS results will be distributed using the same system.

Follow up strategies to increase retention will include conducting an audit to ascertain the number of mothers that have been enrolled for care and treatment vis-à-vis the number referred from the community or ANC. Community volunteers shall trace mothers who do not turn up for PNC. Male involvement will be encouraged through several activities expected to cause 11,865 men to escort their expecting wives to ANC.

Mobilization and sensitization for PMTCT services will be carried out in the communities using drama groups, radio talk shows, film shows and home visits. All female and male PHAs of reproductive age will be regularly counseled and educated about family planning and PMTCT. Trained ACVs will follow up pregnant women. This will support follow up of newborn babies to ensure early infant diagnosis and care. Sites will also be mentored to compile and submit monthly PMTCT reports on time. More health workers will be trained in PMTCT service delivery. This will be backed up by ongoing technical support supervision and mentorship. Infrastructural improvement to provide more space for counseling and testing and provision of buffer supply of HIV test kits, ARVs, data tools for PMTCT will be done.

During the first six months of the current financial year (FY2011), the project provided support to 12 ART accredited sites including one (Kigorobya HC IV) that newly acquired ART accreditation. By the end of March 2011, 4,419 clients were actively accessing ART services. This was slightly below the expected number of clients on ART (4,533).

During FY2012, EKKP shall facilitate the enrolment of 2,782 clients on ART so as to reach 7,467 clients by the end of March 2012.

The project shall focus on supporting the districts to have 9 additional health facilities accredited to provide ART services while maintaining the capacity of the already existing 11 supported facilities. This will be done through continuous mentorship, technical support supervision and assistance. EKKP shall continue facilitating Integrated Static Outreaches to extend provision of ART services at health facilities not accredited to provide ART while building their capacity towards attaining accreditation to provide ART services in future.

In conclusion, the project shall continue to scale up treatment services so as to improve the quality of life of PLHIV. This is largely in line with the second goal of the National HIV/AIDS strategic plan i.e. To improve the quality of life of PHA by mitigating the health effects of HIV/AIDS by 2012. The aim is to work together with the national HIV care and treatment technical group and the District Health Teams towards provision of quality and sustainable services in the districts.

During the first six months of the current financial year (FY2011), the project provided support towards strengthening ART services for infants and adolescents across the 12 ART accredited sites. These health facilities provided ART services to 300 children and adolescents.

During FY2012, EKKP shall increase scale up services to 971 children and adolescents. Child clients will be facilitated to access a comprehensive package of high quality pediatric care and treatment services.

All ART accredited sites shall be provided with continuous mentorship, technical support and assistance in pediatric treatment. Support supervision will entail assessment of clinic infrastructure, training needs, staffing and other HR issues, logistics, transportation, children/client satisfaction, liaison with families and communities.

In conclusion, the project shall continue to scale up pediatric treatment services as a key component of care to improve the quality of life of infants and adolescents. This is also largely in line with the second goal of the National HIV/AIDS strategic plan. All trainings conducted, policies and guidelines promoted are for the Ministry of Health.