STAR-SW project supports the Ministry of Health (MOH) to increase utilization, access and coverage of quality comprehensive HIV/AIDS and TB services. This district-based and family-focused project aims to: improve uptake and strengthen decentralized HIV/TB service delivery systems, improve quality and efficiency of HIV/TB services, strengthen networks and referral systems to improve access to, coverage of, and utilization of HIV/TB services, and intensify demand generation activities for these services. The project targets 13 southwestern districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. STAR-SW will provide TA to support service implementation by district health offices (DHO) and MOH. This TA will foster the development of innovative approaches and rapid expansion of quality services and effective program management systems, while keeping the responsibility of the service implementation with the district, thus establishing sustainable quality services beyond the life of this project. Promoting cost effective approaches such as on the job training and non-residential training will reduce program costs. MOH and PEPFAR/Uganda have identified key strategies to advance the scale-up of both adult and pediatric treatment. As such, STAR-SW will implement the same strategies in its districts and adjust for context at activity level as needed. .STAR-SW M&E plans include quarterly reports to USAID with identified process indicators to monitor the projects progress towards achieving results and objectives, PEPFAR semi-annual and annual reporting, and annual survey report from Lot Quality Assurance Sampling Survey Methodology (LQAS). No Vehicle procurement planned in COP 2013 funding request.

PEPFAR will focus on supporting the Government of Uganda (GOU) to further expand access to HIV care and support with the goal of achieving 80% in care by 2015. STAR-SW program will support the provision of care services to 46,550 HIV positive adults as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals receiving a minimum of one clinical care service. This is a subset of the overall care target. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations such as truck drivers, fishermen, commercial sex workers and MSMs. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. STAR-SW will be expected to implement approaches to promote an effective CoR model and monitor key indicators along the continuum.

STAR-SW will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance including the strengthening of PHDP, the use of linkage facilitators to increase linkages and referrals, the implementation of quality improvement for adherence and retention, pain and symptom management, and support to targeted community outreaches in high prevalence hard to reach and underserved areas.

In line with MoH guidance, focus will be placed on increasing access to CD4 assessment among pre-ART clients for early/timely ART initiation. This has been a major bottleneck for treatment scale up in the PEPFAR program. Working with the Central Public Health Laboratory and other stakeholders, CD4 coverage will be improved from 60% currently to 100% over the next 12 months. STAR-SW will support a sample referral network from supported sites to identified CD4 hubs under the national CD4 expansion plan. STAR-SW will monitor and report clients access to CD4 hubs in quarterly reports to USAID.

STAR-SW will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, STAR-SW will work with National Medical Stores, Joint Medical Stores and Supply Chain Management Systems for other HIV commodities (cotrimoxazole, lab reagents). STAR-SW will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities.

In addition, STAR-SW will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. STAR-SW will collaborate with other key stakeholders for provision of required wrap around services including, family planning.

The program will be aligned to the National Strategic Plan for HIV/AIDS (2011/12 2014/15), support and strengthen the national M&E systems, and work within district health plans. STAR-SW will work under the guidance of MoH AIDS Control Program (ACP) and Quality Assurance Department for trainings, mentorship and support supervision.

STAR-SW will ensure gender awareness and issues are integrated in programs to ensure equitable access to care and treatment services such as identifying and addressing barriers that women and men may face in adhering to treatment or receiving ongoing care.

STAR-SW will focus on supporting the GOU to scale up TB/HIV integration in addition to the PEPFAR goal to achieve TB screening of 90% (731,690) of HIV positive clients in care. STAR-SW will contribute to this target by screening 46,039 HIV positive clients for TB and starting 1,535 on treatment. This target was derived using burden tables based on district HIV prevalence and treatment need.

STAR-SW will improve intensified case finding (ICF) and the use of the national ICF tool as well as improve diagnosis of TB among HIV positive smear negative clients, extra pulmonary TB and pediatric TB through GeneXpert and fluorescent microscopy. STAR-SW will support MDR-TB surveillance through sputum sample transportation to Gene Xpert hubs and receipt of results at facilities. In FY13, STAR-SW will ensure early initiation of all HIV positive TB patients on ART through the use of linkage facilitators and/or the provision of ART in TB clinics. STAR-SW will increase focus on adherence and completion of TB treatment, including DOTS, through use of proven low cost approaches. A TB infection control focal person will be supported to enforce infection control at facilities using interventions such as cough hygiene, cough sheds and corners, fast tracking triage by cough monitors, ensuring adequate natural ventilation, etc.

In addition, STAR-SW will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. STAR-SW will collaborate with other key stakeholders at all levels for provision of required wrap around services. The program will be aligned to the National Strategic Plan for HIV/AIDS and National TB Strategic Plan (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. STAR-SW will work under the guidance of MoH AIDS Control Program, National TB and Leprosy Program and Quality Assurance Department in trainings, TB/HIV mentorship and support supervision. Additionally, STAR-SW will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

STAR-SW will focus on supporting the GOU to further expand pediatric HIV care and OVC with the goal of achieving universal access to care by 2015. STAR-SW will target 4,604 HIV positive children with care and support services contributing to the overall PEPFAR target of 73,169 HIV positive children receiving at least one clinical care service. STAR-SW works through public health facilities and will leverage resources from MOH in form of human resources and infrastructure both of which are major variables in the care cost. More resources will be leveraged from the Adult ART since as the same health workers provide ART services to both adults and children. Furthermore, the pediatric care budget excludes commodities (drugs, basic care kits, HIV test kits, lab reagents) which will be procured centrally.

STAR-SW will provide comprehensive child friendly services in line with national guidelines and PEPFAR guidance, improve adolescent services, strengthen linkages and referrals using linkage facilitators, implement quality improvement for adherence and retention, and provide support to targeted community outreaches in high prevalence hard to reach and underserved areas. EID services and focal points at facilities will be scaled up to ensure follow up and active search of exposed children in facilities and communities to enable early enrolment of children in care. Focus will be on scaling up low cost approaches, such as use of caretaker support groups to support retention in care. STAR-SW will mobilize communities and undertake targeted activities such as Know your child status campaigns to identify more children. Focus will be placed on improved assessment of pre-ART children for ART eligibility to ensure timely initiation on treatment. STAR-SW will support retention of adolescents in care and ensure smooth transition into adult life using expert peer and adolescent support groups. They will be provided with PWP/PHDP services including, sexual and RH services, psychosocial support, and life skills training. Lessons learned from the planned national adolescent service assessment will be incorporated into activities.

A key priority will be to establish strong referrals between OVC and care and support programs to ensure HIV positive children are linked to OVC services, and children provided with OVC services are screened for HIV and appropriately linked to care and support. STAR-SW will also support the integration of HIV services in routine pediatric health services, including the national Child Health Days. STAR-SW will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. STAR-SW will also liaise with National Medical Stores, Joint Medical Stores and Supply Chain Management Systems for ARVs and other HIV commodities (cotrimoxazole, lab reagents). STAR-SW will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities. STAR-SW will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. STAR-SW will collaborate with UNICEF and other key stakeholders at all levels for provision of required wrap around services.

STAR-SW will work under the guidance of MoH AIDS Control Program and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and support supervision.

During FY2012 STAR-SW will assist the Ministry of Health (MOH), working in collaboration with the Central Public Health Laboratories (CPHL), to establish seven hubs. The locations include Kitagata, Kambuga, Kisoro, Itojo and Rushere hospitals and Ruhoko, Rwekubo health centers in Southwestern Uganda.

The major focus of STAR-SW support will be: 1) building CD4 capability in three sites with no high throughput CD4 machines including Kambuga, Kisoro, and Itojo (the remaining four hubs do have existing CD4 capability, 2) strengthening specimen referral and result transmission network, 3) improved laboratory infrastructure, 4) improved facility-level quantification and reporting to reduce CD4 reagent stock out and 5) assisting the labs to implement the WHO recommended stepwise strengthening laboratory management towards accreditation (SLAMTA) with the aim of achieving the minimum of the WHO three stars by September 2014. STAR-SW will also work with district officials and relevant stakeholders to recruit 11 lab technologists and ten lab technicians to ensure that all the seven hubs have the necessary human resources required to run their laboratories at an optimal capacity.

STAR- SW will work with strengthening Ugandan systems for treating AIDS nationally (SUSTIAN) and supply chain management systems (SCMS) to ensure that CD4 machines have regular preventive maintenance to reduce equipment downtime.

In addition to the seven hubs, STAR SW will also ensure that the 35 facilities in Southwestern Uganda that were allocated PIMA point of care CD4 analyzers receive the necessary cartridges, reagents, and supplies through the national medical stores by assisting the facilities to quantify need and project gaps in a timely manner.

In FY 2012, STAR SW is funded to support SI Pivot 3 Strong/robust basic M&E systems at service delivery points and districts across 13 districts in Southwestern Uganda. It aims at generating strategic information that serves to inform national policy and decision making, tracking program targets including outcome and impact measurements, evidence-based programming and health systems strengthening. This will involve adapting, developing and harmonizing tools for data analysis, presentation, interpretation and use with a major focus towards district evaluation studies conducted through LQAS. Routine M&E activities will focus on strengthening the capacity of SI staff to perform better data analysis, presentation, interpretation and data quality improvement (Developing and Maintaining M&E Systems, including data quality assurance, Periodic Performance Reports) and program evaluations.

The district local governments capacity for data collection, analysis, reporting and utilization through the already established management information system, will be strengthened so that quality program data is reported from the districts to MOH.

LQAS will be institutionalized through collaboration with STAR E LQAS to support the 13 districts as a means of collecting information for monitoring, evaluation and guiding district strategic planning. LQAS surveys will be conducted in each district for: 1. Community, 2. Health facility assessment and 3. Service delivery performance through SPAIs. Existing program data will be used to evaluate and improve program implementation.

STAR-SW support will be the integration of sector data and annual performance measurement to facilitate evidence-based programming at district level.

Data Quality will be ensured through fostering the use the approved GoU data collection tools, conducting regular DQAs and facilitating quarterly district data review meetings. The latter will provide a forum for district leadership and health care staff to review their performance, share experiences, and brainstorm on data-driven solutions for district and site-level challenges.

Support will be provided as need be to MoH in the roll-out of the revised HMIS and DHIS2 guided by SDS and other stakeholders. The roll out will initially focus on training of district biostatisticians, the HMIS focal persons as well as various district specific technical leads as trainer of trainers, who will act as training leads for each of their districts. It will also support the operationalization of national OVC MIS at the lower levels.

In COP 2012, STAR-SW will aim to increase coverage of VMMC services in all 13 supported districts. The districts have high HIV prevalence in the general population, high HIV prevalence among women, and low circumcision prevalence. Interventions will focus on all eligible men (including adolescents) in the "catch up" phase to identify persons who are sexually active and at higher risk of acquiring HIV. Efforts will be made to target the hard to reach populations and communities, particularly the fishing communities. A target of 83,780 men will be circumcised by the STAR-SW project.

VMMC will be offered as part of the STAR-SW comprehensive HIV prevention package, which includes promoting delay of sexual debut, abstinence, the reduction in the number of sexual partners and being faithful, providing and promoting correct and consistent use of male condoms, providing HTC services, and the treatment of STIs and referral of HIV+ men to appropriate care and treatment services. STAR-SW will integrate VMMC services as part of the continuum of response (COR), contributing to the accessibility of reproductive health care for men, improved male involvement in care and treatment services, and improved health-seeking behaviors of female partners for HTC, ANC, and eMTCT.

To attain the above target, the STAR-SW project will use multiple approaches to scale up VMMC incorporating stand-alone sites with dedicated team, integrating VMMC services within 75 health facilities, and hosting outreaches/camps. STAR-SW will use the Model for Optimizing the Volume for Efficiency (MOVE) as a means to optimize the efficiencies and increase the volume safely in all VMMC service outlets. A total of 117 service providers will be trained from Rakai Health Center, Walter Reed Project and IDI/IHK (public-private partnership). Quality improvement and external quality assurance will be integrated as part of the minimum package of VMMC services. The STAR-SW project will build the capacity of providers to use the Non-surgical VMMC devices (PrePex) in the supported sites when approved by MOH.

The STAR-SW project will implement community campaigns to create acceptance and demand for VMMC through a mix of approaches: 1) a peer-to-peer strategy for interpersonal communication; 2) the use of linkage facilitators to mobilize men; 3) community mobilization; and 4) the use appropriate channels of communication including print and electronic mass media. The goal is to increase knowledge of HIV status between PHLA and their partners, reduce the risk of HIV transmission, and reduce HIV acquisition among persons at high risk for infection. Emphasis will be placed on increasing linkages of HIV+ clients from VMMC to care and treatment services as part of the COR.

STAR-SW will enhance monitoring & reporting through the MOH SMC Operational Centre and HMIS tools and periodic data quality assessments (DQA). Data use at facility level will be strengthened through supporting M&E focused in-service training for health workers to foster evidence-based decision-making and program improvement.

The STAR-SW program will contribute to the overall HTC goals for PEPFAR by increasing access to and use of essential counseling and testing services for the most-at-risk populations and other key populations determined by existing data on HIV prevalence in Uganda. This program will contribute to the continuum of response by linking clients to other STAR-SW-implemented health services including HIV Care and Treatment, PMTCT, VMMC, TB, and social support services in the community with the aim of increasing demand and adherence for HIV+ clients.

During the FY 2011, a combination of strategies were used to provide HCT services including stand-alone HIV counseling and testing at various health facilities, integrating HCT into the community mobilization and demand generation campaigns and the rolling-out of PICT in four districts. There was also focus on integrating HCT in ANC, rolling-out of HCT targeting key populations and emphasis on couples HCT. Going forward, STAR-SW will provide HCT services targeting 105,000 individuals in the following 13 southwestern districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale.

In addition to discordant couples and those with multiple concurrent partnerships, a target of 9,600 individuals of the key population group will be targeted in the following locations:

Commercial sex workers and their clients and partners in Katuna border, Kanaba, Kisoro TC, Ntungamo Municipality, Kihiihi Town Council (TC) near Ishasha border, Bwindi community, Rwenshama fishing community, Rweshamire TC, Rugaaga TC, Ndiizi, Orukiinga, Kajaahu, Rutiindo border, and Kabuyanda.

Long distance truck drivers and their partners in Katuna Border, Ntungamo TC, Mirama hills border, Rubaare town, Kisoro TC, Bunagana Border Post, Chanika TC, Kaberebere, and Isingiro TC, fisher folks/fishing communities in Katunguru, Kazinga, Kahaha, Kishenyi, Rwenshama, Rukinga, Kahirimbi, Nyanga, and Rubaare landing sites (Kiruhura)

STAR-SW will work with MOH, districts and CSOs to implement the following interventions:

1) Scale-up of HCT services through: capacity building of health workers in PICT targeting all HC IIIs, HC IVs and at least 30% of all the HC IIs in the region; conducting demand generation campaigns for HCT services; strengthening HCT information management system in the targeted facilities through the provision of newly designed MOH M&E tools including HCT registers and CUE cards.

2) Enhance couples HIV counseling and testing through: identifying discordance and provision of appropriate services (disclosure, support for disclosure, linkages to PWP services, condoms etc); increase awareness on the benefits of couples HCT and roll out interventions such as integrating couples week campaigns into ongoing outreach services. Couples HCT will be integrated into all planned HIV prevention activities.

3) Ensuring a continuum of response from testing into care and treatment. HIV negative individuals will be targeted with preventive services including retesting for pregnant women and other populations at continued risk of acquiring HIV, behavior change communication messaging, and where discordance occurs, PwP messaging for the couples.

In the revised COP12, the key activities of the STAR-SW project aim to ensure a balanced portfolio that will address prevention needs of the primary target groups, including seniors and youth, through the implementation of high impact interventions in 13 districts in the southwestern region. In this effort, STAR-SW will focus on addressing the key bottlenecks to increasing condom use by inceasing accessibility, availability and acceptability of condoms among the target populations. STAR-SW will also implement targeted interventions for MARPS in the high-burden districts and hot spots and the PDHP in order to ensure access to condoms and other prevention services as needed.

Deliberate efforts will be made to promote condom use among key populations, serodiscordant couples, and multi-partner relationships in rural and urban populations. STAR-SW will support condom distribution and promotion by increasing the number of distribution outlets to 250 locations at the facilities level, community level, at landing sites and hard to reach areas. STAR-SW will also engage with social marketing partners to increase distribution and promotion of condoms through the hospitality industry, particularly bars and hotels at landing sites and hot spots. The following hot spots will be targeted during FY 2013: Katuna, Kamuganguzi; Kisoro TC, Kanaba, Muhindra, Bunagana, Chanika, Mupaka ; Ntungamo Municipality; Kayonza, Kihiihi, Bwindi , Bwindi community , Rwenshama, Ruknugiri TC, Kebisoni, Buyanja ; Rweshamire TC, Rubaare, Mirama Hills, Kitwe, Ntungamo TC, Pearl Flowers; and Rugaaga T/C, Ndiizi, Orukiinga, Kajaahu, Rutiindo border, Kabuyanda, Nyakivale, Rukinga, Mabona, Nyamuyanja. In order to de-stigmatize condoms at all levels, the projects advocacy strategy will engage the religious and political leaders to establish norms that promote faithfulness in marriage and abstinence among the unmarried.

Despite the fact that STAR-SW will not receive AB funding, they will provide age- appropriate and comprehensive risk reduction strategies for young people who access their sites. Such programs will include promotion of delayed sexual debut, reduction in the number of sexual partners and being faithful, as well as providing and promoting correct and consistent use of male condoms.

Amongst the MARPS, the interventions will focus on increasing perception of HIV risk associated with sex work, strengthening PwP among infected MARPs at facility and community levels, and scale up of evidence-based behavioral interventions. STAR-SW will target all clients in care and treatment with PHDP interventions. To reach 34,813 people with prevention interventions, STAR-SW will create a demand for services by applying supportive behavior change communication. Such results will be found through community campaigns to create acceptance and demand for condoms by: 1) promoting peer-to-peer strategy for interpersonal communication; 2) using linkage facilitators to mobilize men; 3) supporting community mobilization; and 4) using appropriate channels of communication including print and electronic mass media. Program monitoring and evaluation activities will be supported within this budget to strengthen the collection of data through national HMIS tools and to improve the technical quality of data through periodic data quality assessments. Data use at facility level will be strengthened through supporting M&E/SI focused in-service training for 100 of health workers.

In addition to COP2012 funds, STAR-SW will receive $1,032,384 from PMTCT Acceleration funds to support the rollout of Option B+ in 13 districts in the southwestern region. STAR-SW will facilitate the transition of 195 eMTCT sites to Option B+ sites during the period of January 2013 to March, 2013. HIV counseling and testing services will be provided to 129,350 pregnant & lactating women, helping to identify 9,283 HIV positive pregnant women. Of those women, 7,171 will be initiated on HAAR for life while 1,266 will be provided with ARV prophylaxis. Furthermore, infant ARV prophylaxis and EID will be provided to 9,283 exposed babies. As a result of this program, the four PMTCT prongs will be supported alongside the goals of virtual elimination of MTCT and keeping mothers alive. To achieve the above, STAR-SW will implement the following:

1) Improving utilization of eMTCT services to reach more HIV infected pregnant women as early as possible during ANC, L/D, and post-partum periods; 2) Decentralize treatment and Option B+ through the accreditation of all supported sites. Key activities will include site assessments for accreditation, identification of training needs, procurement of equipment, printing of M&E tools, job aides, and Option B+ guidelines, training of 1,365 service providers, and sample referrals for CD4+ and EID. The transition to Option B+ in the STAR-SW region will start initially at the ART sites followed by the accreditation of all Non-ART PMTCT sites to provide Option B+; 3) Intensive M&E at the facility and community levels at the STAR-SW supported sites through cohort tracking of mother-baby pairs and electronic data reporting for effective Option B+ monitoring and program management. Mobile phone technology will be used to remind mothers and their partners on appointments, EID results, and ARV adherence. Home visits will be conducted to trace those who are lost to follow-up; 4) STAR-SW will enhance the quality of eMTCT services through quarterly joint support mentorships at all eMTCT/ART sites. Site level support will entail cohort reviews of adherence rates and retention rates, data management, ensuring availability of supplies (commodities, HIV test kits, tools, job aides and ARVs), and addressing existing knowledge gaps on Option B+; 5) The STAR-SW project will integrate voluntary and informed family planning (FP) services based on respect, womens choices, and fulfillment of their reproductive health rights. FP sessions will be integrated into eMTCT trainings for all service providers. Futhermore, FP counseling, education, and information will be provided to all women during ANC, labor and delivery, postnatal periods and in care and treatment settings. STAR-SW will collaborate with existing FP partners (Marie Stopes Uganda, STRIDES, and UHMG) for linkage to RH/FP services.

Retention of HIV positive pregnant women on ART will be enhanced through implementing a family- focused service delivery model within the PMTCT/MNCH settings and through family support groups. Village health teams will be utilized to enhance follow-ups and facility referrals.

In line with Ministry of Health and PEPFAR/Ugandas identified key strategies to advance ART scale-up in Uganda, STAR-SW will implement the following:

Support decentralization of ART services aimed to enroll at least 10,674 new HIV positive adults on treatment and support 23,983 HIV positive adults on ART by September 2013. This number contributes to national and PEPFAR targets of 190,804 new clients and 490,028 individuals on treatment. This target is not a ceiling, allowing for higher achievements with continued program efficiencies. Priority will be given to enrollment of HIV+ pregnant women, TB/HIV patients, and key populations. STAR-SW will support the MoH roll-out of Option B+ for eMTCT through: accreditation of health facilities as per MoH accreditation scale-up plan and training, mentorship and joint PMTCT/ART support supervision. At the facility level, STAR-SW will support ART/PMTCT integration through the pilot of feasible service delivery models, such as same-day integrated HIV clinics. Linkage facilitators across difference service points in facilities and communities will strengthen COR linkages and referrals, as well as ensure early ART initiation for TB/HIV patients. Targeted community outreaches in high prevalence, hard-to-reach and underserved areas will be conducted. STAR-SW will also target key populations using innovative approaches including setting up specialized services, such as moonlight services.

STAR-SW will implement quality improvement initiatives for the ART framework: early initiation of ART eligible clients on treatment; improve adherence and retention; monitor treatment outcomes. Use of innovative low-cost approaches for adherence, retention and follow-up, such as phone/SMS reminders, appointment registers, and alert stickers, will be supported. Special focus will be placed on adherence and retention of women enrolled under Option B+ and increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. STAR-SW will support the sample referral network in line with the national CD4 expansion plan and will monitor and report clients access to CD4 in quarterly reports.

STAR-SW will work with UHMG for provision and distribution of basic care kits to clients and work with National Medical Stores, Joint Medical Stores and Supply Chain Management Systems for ARVs and other HIV commodities (cotrimoxazole, lab reagents). STAR-SW will build the capacity for facility staff to accurately and efficiently report, forecast, quantify and order commodities, and strengthen pharmaceutical management by implementing the MOH-tool package called supervision and performance assessment strategy (SPAS). In addition, STAR-SW will work with USG partners and stakeholders for provision of required wrap-around services, particularly family planning and malaria prevention.

Funding has been provided through SDS program to support the recruitment of additional staff in STAR-SW supported districts to meet the targets. STAR-SW will integrate gender awareness and issues in programs to ensure equitable access to care and treatment services, such as identifying and addressing barriers that women and men face in adhering to treatment or receiving ongoing care.

STAR-SW will work under the guidance of MoH ACP and Quality Assurance Department in trainings, ART/PMTCT mentorship and support supervision.

In line with Ministry of Health and PEPFAR/Ugandas identified key strategies to advance ART scale-up in Uganda, STAR-SW will support the decentralization of pediatric ART services aimed at enrollin at least 2,668 new HIV positive children on treatment and support 3,584 children on ART by September 2013. This will contribute to overall national and PEPFAR target of 39,799 new clients and 64,072 children current on treatment. To achieve these targets, STAR-SW, working through public health facilities will leverage resources from MOH in form of human resources and infrastructure both of which are major variables in the treatment cost. Also, the pediatric treatment budget excludes commodities (drugs and lab reagents) which will be procured centrally and delivered through the National Medical Stores.

STAR SW will enhance early identification, linkage and retention of infants and children who are exposed to or who are HIV+ into care and treatment through roll-out of proven cost effective interventions: RCT,VCT & EID for identification; use of standard referral forms, linkage facilitators and community follow-up mechanisms.

STAR-SW will also strengthen HR capacity to provide comprehensive pediatric services. Through training (including pediatric HIV counseling); integrating quality improvement approach into service provision, mentorships and in-service training.

Priority will be to establish strong referrals between OVC and care and support programs to ensure children on treatment are linked to OVC services, and children provided with OVC services are screened for HIV and appropriately linked to treatment.

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

STAR-SW will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, STAR-SW will liaise with National Medical Stores, Joint Medical Stores and Supply Chain Management Systems for ARVs and other HIV commodities (cotrimoxazole, lab reagents). STAR-SW will build the capacity for facility staff to accurately and timely report, forecast, quantify and order commodities by implementing the supervision and performance assessment strategy (SPAS), an MOH tool package.

In addition, STAR-SW will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services.

The program will be aligned to the National Strategic Plan for HIV/AID (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. STAR-SW will work under the guidance of the MoH/AIDS Control Program and Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework and support supervision.

Funding has been provided through SDS program to support the recruitment of additional staff in STAR-SW supported districts to meet the achievement of the targets. This will be done in collaboration with the Health Systems Strengthening technical working group.