PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
This activity also relates to activities in Abstinence and Being Faithful (8437), Counseling and Testing (8433), Condoms and Other Prevention (8432), Palliative Care:Basic Health Care and Support (8435), Palliative Care: TB/HIV (8431), Strategic Information (8436), Other/Policy Analysis and Systems Strengthening (8838), as well as Treatment: ARV Services (8845).
The Uganda Program for Human and Holistic Development (UPHOLD) is a 5-year bilateral program funded by USAID. UPHOLD has continuously supported the national efforts to improve the quality, utilization and sustainability of services delivered in the three areas of HIV/AIDS, Health and Education in an integrated manner. In partnership with the Uganda government and other players, UPHOLD has strengthened the national response to the HIV/AIDS epidemic. Within the National Strategic Framework, UPHOLD continues to work through local governments, the private sector and civil society organizations (including both faith based and community based organizations) towards improved quality of life and increased and equitable access to preventive and clinical services.
Achievements to date: The number of service outlets providing minimum package services according to national standards is 41 reaching 10,494 pregnant women with counseling, testing and results for PMTCT. 433 pregnant women have been provided with a complete course of antiretroviral prophylaxis in a PMTCT setting. 141 health workers have been trained in the provision of PMTCT services according to national standards.
UPHOLD interventions will aim at contributing to the national PMTCT Phase II (2006-2010) strategy whose focus is to roll-out the revised PMTCT policy, support to the holistic implementation of the four-pronged PMTCT strategy (primary prevention; family planning; provision of ARV prophylaxis; care and support). This phase is focused on the consolidation of services to increase uptake, male involvement, strengthening of family planning services, and improvement of comprehensive care for HIV+ women, their spouses and their exposed children through early HIV diagnosis and linkages to care.
An estimated 36,000 HIV+ pregnant women will receive PMTCT services from 135 outlets (including 60 sites formerly supported by AIM). These sites are mainly Health Centre (HC) IIIs and IVs in 25 districts that include those supported by UPHOLD and those formerly supported by AIM but exclude sites that fall under the Northern Uganda project as well those districts UPHOLD shares with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) which include Rakai, Mayuge, and Mbarara districts). This activity will also support the integration of PMTCT into goal-oriented antenatal care (ANC) services as well as linking PMTCT services to intermittent presumptive treatment of malaria (IPT) in pregnancy activities.
In collaboration with the Ministry of Health, this activity will also focus on the training of existing service providers (including counselors, mid-wives, laboratory staff and data and records personnel etc.) in rolling out the revised National PMTCT policy. Additionally, in collaboration with other stakeholders, new/updated IEC materials (including job aides) will be reviewed, printed and distributed for use by different target groups with a focus on increasing uptake of PMTCT services (including Nevirapine uptake by both mothers and babies) and creating positive behaviours such as supportive male involvement, appropriate infant feeding practices and IPT uptake. Furthermore on-going site based support will be provided to service providers by joint teams from the Ministry of Health and UPHOLD to ensure achievement of prior agreed upon service standards that are set by the Ministry of Health. The integration of family planning education into the PMTCT pre-test counseling will be supported as well as the family centered model for HIV care through PMTCT and reproductive health. This model envisages the use of HIV negative pregnant women to access counseling and testing for their male spouses and link them to other reproductive health services. UPHOLD also plans to train partners on addressing gender based violence issues in relation to HCT and PMTCT uptake. Those receiving this training will be charged with conducting action oriented community discussions on issues of gender power relations aimed at reducing gender based violence, increasing male involvement and facilitating couple dialogue on shared disclosure and discordance. For the activities described above, a total of 260 additional service providers will be trained.
This activity will also focus on community mobilization, education and participation to increase psychosocial support for HIV positive mothers and their spouses as a strategy to
enable them to cope and also to access care services. Psychosocial support groups will be trained and facilitated to engage in activities such as peer counseling on disclosure of HIV status to spouses, partner support, alternative and safe breast feeding, living positively and referral of clients for further care, support and treatment including anti-retroviral therapy. Tailored training will be provided to members of these groups to enable them to effectively engage in community mobilization through testimonials and dance and drama and to propagate messages aimed at reducing stigma, gender based violence and increasing male involvement in PMTCT services. Additionally, as part of the strategy to increase uptake for PMTCT services by young women, known ‘influencers' such as grandmothers and aunts will be targeted for IEC. UPHOLD will also tap into the expertise and experience of EGPAF (a USAID Funded PMTCT Program) to build the competence of psychosocial support groups to provide preventive counseling, on-going psychosocial support to HIV+ mothers and their spouses and increase treatment literacy and adherence to treatment. Those who are found negative through HIV testing (estimated at 93%of mothers test) will be supported to remain negative through various methods such as couple counseling, correct and consistence condom use and IEC.
In collaboration with other Presidential initiatives such as President's Malaria Initiative (PMI), HIV+ mothers through their PSS groups, will also access resources such as treated mosquito nets to prevent malaria as an integrated service in goal oriented antenatal care and PMTCT service delivery. This will be done through distributing insecticide treated nets to 1,500 HIV+ mothers registered in the PMTCT program. UPHOLD will also leverage PMI to integrate IPT into ANC clinics.
OGAC Reviews: If UPHOLD is having problems, this should be noted. Need more contextual info for why this is.
We are not clear about the problems the reviewers are referring to. UPHOLD's FY 06 Annual Report 2006 data has shown significant improvement in PMTCT cascade indicators in keeping with the entire USG portfolio improvement.
This activity also relates to activities in Abstinence /Being Faithful (8775), Condoms and Other Prevention (8467), Palliative Care: Basic Health Care and Support (8468), Palliative care: TB/HIV (8469), Counseling and Testing (8470) , HIV/AIDS Treatment /ARV Services (8472), Laboratory Infrastructure (8473), Strategic Information(8474), and Other/Policy Analysis System and Strengthening (8475).
The NUMAT project, which covers the sub regions of Acholi and Lango, was awarded in August 06 with FY 06 resources. Year 1 activities will be implemented over a 9 month period and will build on what has been achieved by other USG supported projects, including AIM, UPHOLD and CRD. UPHOLD and CRD operations in the North are coming to an end in FY07, and NUMAT will serve as the primary district based HIV/AIDS program for the USG.
A differentiated strategy is being implemented by the project in the two sub regions. In Lango, where the security situation is more stable and displaced people have begun going back to their homes, NUMAT will continue to support activities aimed at strengthening existing community and facility based HIV/AIDS/TB and malaria services. Services at static sites will be strengthened to meet the increasing demand by the returning population while other particular services will continue to be scaled up at lower levels of service delivery.
In the Acholi region, where conflict remains an issue and satellite camps are being created as the security situation stabilizes, efforts will continue being put on extending services to populations in camps particularly the peripheral camps. The project will continue working with a host of stakeholders including USG projects, UN, and humanitarian efforts, to scale up mobilization and service provision and referral for HIV/AIDS/TB and malaria services for the camp populations.
In view of the acute human resource constraints facing the conflict affected districts of the North, one specific area that the project will put focus on is to work with other stakeholders to innovatively address the critical human resource gaps in the region. NUMAT will collaborate with UNICEF and the MOH in the implementation of the minimum package of Health Facilities support and with others to design and implement appropriate incentive packages that will be linked to a broad human resource support strategy in conflict and post conflict districts.
NUMAT will also work in close collaboration with all of the key stakeholders supporting the North including the GOU, local government political and technical officials, UN agencies, humanitarian organizations, local faith and community based organizations and USG supported activities
Planned key achievements in year 1 include: building and strengthening the capacity of selected hospitals and HCIV's to offer PMTCT within the facilities and to beginning outreach services to the camps located beyond the municipalities. PMTCT clients will also be actively referred to other services including psychosocial support groups for pregnant women, palliative care and ART treatment. Linkages and referrals to OVC programs for the children (HIV+ and HIV-) will be facilitated.
Building on year 1 achievements, FY07 resources will support scaling up PMTCT services to cover lower health units in order to reach pregnant women and their families living outside of the municipalities and in IDP camps. Key activies will support the priorities of the national PMTCT program and will include: infrastructure strengthening (laboratories, counseling rooms, delivery wards and meeting space for support groups), training PMTCT counselors, traditional birth attendants and other health workers, and support to the pull component of the national logistics system. The project will work closely with CBOs to support integrated outreach services from health units to camps, with a focus on mother/child follow up, counseling for breastfeeding and infant nutritional support.
Activities to improve the uptake of services will focus on the role of men, older women and community leaders in advocating, mobilizing communities, facilitating and supporting healthy choices for women and their families. Gatherings of men such as drinking groups will be targeted for IEC/BCC. Couples counseling will be encouraged and programs providing incentives, such as delivery kits, to mothers to deliver in health centers will be
supported. Facilities will work in close collaboration with PSS groups and CBOs and other organizations providing "wrap-around" services to support mothers to disclose their status to family members as well as link them to PHA groups and other CBOs. Active referrals to care and treatment for pregnant women, their children and spouses will be facilitated.
With FY007, the project will leverage PMI resources to support the delivery of IPT in ANC clinics in the North.
plus ups: Several USG projects have come to a close in Northern Uganda, including AIM, UPHOLD and their respective subgrants with AVSI. NUMAT is the dedicated USG program working to support HIV/AIDS in the north and collaborates closely with the UN, other USG partners and the host country. With strong indications of continuing peace, there remains a significant gap in support to PMTCT services. NUMAT in partnership with AVSI will work to fill the gap through expanded district coverage. NUMAT will support all elements of the USG PMTCT program. Focus will be placed on reconstruction of health service systems and reaching the population beyond the municipalities.
This activity also relates to Condoms and Other Prevention (8403) , Counseling and Testing (8404), Palliative care: Basic Health Care (8405) and Palliative Care: TB/HIV (9058).
AIDS Information Centre-Uganda (AIC) is a Non-Governmental Organization established in 1990 to provide the public with Voluntary Counseling and Testing (VCT) services on the premise that knowledge of ones own sero-status is an important determinant in controlling the spread of HIV. AIC also uses HCT as an entry point to HIV/AIDS service-provider initiated services including prevention of HIV transmission, treatment of opportunistic infections, PMTCT services and ART referrals and other care and support services. In FY 07 AIC will continue contributing towards the national efforts of decreasing the gap of 79% of Ugandans who would want to know their HIV status but are unable (Uganda Behavioral sero-survey 2005).
AIC will continue strengthening its staff and members of Post test clubs (PTC) with skills in designing/adapting , dissemination and counseling using AB messages and approaches. This will enable the trained persons to effectively communicate AB messages to their peers during drama performances. PTCs will intensify counseling among each other during fellowship sessions and when in contact with the general community on further prevention, strategies, reduction of sexual partners and promoting faithfulness among couples. It is estimated that the retrained 160 PTC members will reach 84,000 people including youth and adults.
AIC will continue to support activities related to promoting abstinence and Being Faithful prevention strategies. This will be achieved through incorporating AB messages in all counseling protocols. Special focus will be targeted to couples to increase couple dialogue, counseling on partner reduction, and remaining faithful to each other, handling disclosure in the event of discordant HIV test results. Music, dance and drama will be used to reinforce couple dialogue in the community. It is estimated that 30,000 couples will be reached with AB messages through counseling sessions this funding period
As part of AIC youth programs to increase access to HCT through the Youth Corners in the branches, youth will be encouraged to participate in AIC led Radio programs and Post test club activities in the community focusing on AB. In addition, in collaboration with other AB programs, AIC will receive IEC materials that promote abstinence and distribute them to Youth who seek HCT services in AIC centers. Specific interventions and training in disseminating AB messages, responsible sexuality, and Being Faithful will be central activities for the youth programs. Other message distribution outlets will include peer educators as well as those promoting ‘being faithful' such as religious and community leaders for use at premarital counseling sessions. Trained peer educators will reach out to their fellow youth with HIV prevention related messages and other referral information on PMTCT, ART services. It is estimated trained youth peer educators will reach 39,000 youth with AB messages.
Recognizing that few partners have AB focused programs for institutions of higher learning, AIC will conduct outreach Music, dance and drama services reaching universities, vocational colleges including Core Primary Teacher Colleges in partnership with the ESWAPI project. In addition, Branch Centre Post-Test Clubs will be supported to conduct drama outreaches to communities with prevention messages emphasizing AB. AIC will also air weekly "Be faithful" radio talk shows, which will be adapted from existing programs to ensure consistency and will be aired in the main local languages covering the AIC branches. In collaboration with other existing partners promoting AB programs, Radio presenters will be oriented on concepts and benefits of ‘being faithful', and partner reduction, prevention of stigma and discrimination, benefits of disclosure and prevention of gender-based violence. This will ensure accurate and context appropriate information is communicated to the appropriate audiences. The messages will target out-of-school youth, students of institutions of higher learning reaching an estimated 300,000 people.
This programming will be closely coordinated with the YEAH program to which AIC serves as an advisor. Specifically, messages and materials from the "B A Man" campaign will be reinforced through this programming.
The Uganda Program for Human and Holistic Development (UPHOLD) is a 5-year bilateral program funded by USAID. UPHOLD has continuously supported the national efforts to improve the quality, utilization and sustainability of services delivered in the three areas of HIV/AIDS, Health and Education in an integrated manner. In partnership with the Uganda government and other players, UPHOLD has strengthened the national response to the HIV/AIDS epidemic. Within the National Strategic Framework, UPHOLD continues to work through local governments, the private sector and civil society organizations (including both faith based and community based organizations) towards improved quality of life and increased and equitable access to preventive and clinical services.
To date, 313,144 individuals have been reached through community outreach programs that promote HIV/AIDS prevention through abstinence and/or being faithful. 4,000,000 children and other 196,004 individuals have been reached through community outreaches that promote HIV/AIDS prevention through abstinence. 219 individuals have been trained to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful
Although there are positive trends among young people in regards to delayed sexual debut and increased abstinence, the secondary data HIV sero behavioral analysis shows that certain behaviors particularly among adults are regressing towards those of the late 1980s when HIV prevalence was at its peak in the country: there is an increase in casual sex, an increase in multiplicity of partners, and a decrease in condom use with casual partners. A secondary analysis of available faithfulness data from the Uganda HIV/AIDS Sero-Behavioural Survey 2004-05 shows that 88%of men are not lifetime faithful, compared to 56% of women, and only 10% of couples are mutually lifetime faithful.
UPHOLD will continue to support civil society organizations to improve on the gains attained through the existing abstinence programs for the 10-19 year olds, through a combination of in-school and out-of-school programs, media and community mobilization approaches. This activity involves further strengthening and scaling-up of the national Presidential Initiative for AIDS Strategy for Communication to Youth (PIASCY) targeting 4 million primary school children (Primary Three to Primary Seven) in 15,341 primary schools in all the current 76 districts in the country. PIASCY is implemented through the Teacher Development and Management System (TDMS) structure. UPHOLD will continue technical and financial support to core Primary Teachers Colleges (CPTCs) to enable them implement school-based abstinence only activities. This funding will support the increase in the number of PIASCY ‘Centers of Excellence'/Model Schools in the country from 1,078 to 2,156 (from 7%to 14%) of all primary schools. The ‘Centers of Excellence' will be nurtured through on-site supervision and will be expected to mentor other schools through the ripple effect of PIASCY best practices. A model school is a selected school with a catchment area where a comprehensive package of services is provided (training of more teachers in guidance and counseling, more PIASCY materials provided, strengthening PIASCY clubs, provision of incentive grant for outreach activities, support for talk shows and action oriented meetings with the surrounding community supported) so that other schools benefit from the lessons learnt.
This activity will contribute towards increasing the number of primary school children who delay sex until marriage. UPHOLD will support CPTCs through model schools to disseminate prevention communication messages to primary school children through interactive activities which include the strengthening of PIASCY-integrated school clubs, use of PIASCY assemblies and class room messages, and promotion of child-centered participation in use of performing arts festivals as a channel for prevention messages. Aware of the importance of involving parents and communities in promoting responsible sexuality among their children, UPHOLD will support school-community action-oriented meetings to address risky situations that lead to defilement and HIV/AIDS, stigma, and care for affected families with HIV/AIDS and discuss individual and facility roles and responsibilities regarding the same.
In addition, tailor-made talk shows on various topics aimed at creating more risk-free school and community environments will be produced and aired. This activity will address legal issues on sex abuse, harassment, value of virginity, stigma and discrimination, care for persons affected and infected with HIV/AIDS. A total of 6,468 additional teachers will be trained in PIASCY implementation and Guidance and Counseling and 16,170 sets of the
PIASCY, Guidance and Counseling and Community Involvement in Education Tool Kits will be printed and distributed in the 1,078 additional schools.
A component on Information, Education and Communication will target out-of-school youth, couples and the general community to create an enabling environment for sexually active youth to abstain from early sexual activity, reduce sexual partners and to remain faithful to each other. This mass media effort implemented through Radio Listening Clubs will be utilized to transmit messages on benefits of abstinence, reduction of sexual partners and Being Faithful. Experienced organizations such as The Straight Talk Foundation will continue to partner with UPHOLD to implement life skills youth programs aimed at empowering youth and their peers in adopting responsible sexual behavior among youth. The 40 radio journalists trained in promoting responsible sexual behaviors, abstinence and faithfulness in the previous financial year will continue to implement this activity to the targeted audiences and communities. UPHOLD will also continue to support CSO drama troupes to perform targeted music, dance and drama which enhance community dialogue and action planning to address among other things male behavior as a key driver of the epidemic, the dangers of early sexuality and multiple sexual relationships. These performances will also address couple dialogue, faithfulness and non violent behaviors. In addition to the above, UPHOLD will continue to support CSO activities that promote "Be Faithful" and gender based violence reduction among couples. In collaboration with partners such as Tuko Club and Raising Voices, CSO staff will be trained in ‘Be Faithful' messages, couple counseling skills and prevention of gender based violence. It is expected that 5,000 individuals will be trained in this activity and these trained staff will reach out to audiences in their respective areas. All together, an estimated 4.3 million people will be reached by ‘Abstinence and Be Faithful messages and these will include 4,000,000 people exclusive to primary school going children, 300,000 people who include couples and out-of-school youth.
OGAC Review: Again, the UPHOLD program has performed at or above expectations in the majority of areas as evidenced by the 2006 Annual Report and is an important tool to expand reach of services nationally and in key districts. Activity 8437 describes several efforts undertaken by UPHOLD to extend the reach of AB messages and skills. The largest portion of the budget ($2,000,000) targets 4,000,000 children; 5000 teachers and contributes to the scaling up and strengthening of PIASCY, based on implementation to date. We agree with the review team that PIASCY could serve as a best practice model. It is the major reason why the USG Team planned an evaluation of the PIASCY program in FY06, in collaboration with the MOES - this will take place in FY07.
This activityalso relates to Condoms and Other Prevention (8452), Palliative Care: Basic Health Care and Support (8454), Orphans and Vulnerable Children (8453), Strategic Information (8455) and Laboratory Infrastructure (8451).
The AIDS Support Organization (TASO) is an indigenous organization operating in Uganda since 1987. TASO operates 11 service centers and 39 outreach clinics spread across Uganda. TASO provides a full continuum of comprehensive HIV prevention, care, and treatment services for 75,000 active clients (65% of these PHA are female). TASO programs are designed to contribute to achieving the national health and HIV/AIDS strategies. To access services to the neediest PHA TASO runs a vigorous community-arm through field staff, community volunteers, community-based HIV/AIDS leadership structures and PHA networks.
TASO will conduct prevention activities in line with the Uganda National Road-Map for HIV Prevention which aims at accelerating HIV prevention activities including reduction of sexual transmission of HIV, PMTCT, post-exposure prophylaxis, promotion of counseling and testing, disclosure, protection of vulnerable populations, integration of HIV prevention into treatment and prevention of sexually transmitted infections. TASO had earlier on established HIV and STI prevention and these were running routinely as part of the overall services. In FY07/08, there will be special emphasis laid on all HIV/STI prevention activities and the enhancement of quality more than in the past. TASO will also assess prevention activities in terms of contributing to the targets of national roadmap and value-addition to the overall national response. Prevention AB messages tailored to address the HIV/AIDS challenges of specific target groups will be provided. Abstinence-tailored prevention messages will target children, adolescents, students, out-of-school youth and HIV-infected children. In addition under this strategy, the Be-Faithful-tailored messages will target sections of the general adult population deemed to be sexually active and so vulnerable to HIV infection e.g. couples, men and women.
The first A&B component will be conducting Live Radio Talk Shows on key HIV/AIDS topics/themes. Presenters engage listeners in discussions and Q&A sessions through phone-in facilities. Presenters provide information for education and clarification on issues. TASO will conduct 182 radio talks tailored along Prevention AB (i.e. 50% of the total radio talks to be conducted by TASO Centres in Entebbe, Jinja, Mbale, Masaka, Masindi, Soroti Gulu and Rukungiri; each Centre will conduct 1 radio talk per week). The radio talks focusing on AB will be conducted in partnership with FM radio stations operating in various parts of Uganda.
Each TASO Centre will partner with the radio station most listened to by the intended target group. TASO teams comprising of staff and PHA will conduct live presentations over radio and interact with listeners through phone-in facilities. TASO teams will take questions and feedback from the listeners and provide answers, information and clarification. TASO will form the Teams to suit the needs and peculiarities of the target groups so as to ensure lively and effective engagement with the listeners over radio. Partner media houses will give TASO technical support on enhancing the effectiveness of the radio talks. The listener-ship of the radio stations is estimated at over 100,000 people. TASO and UPHOLD will coordinate their radio programming to ensure consistency and effect of messages.
The second A&B component will be Partnering with Schools to enhance effectiveness of the abstinence prevention strategy. Each of the 5 TASO Centres (Gulu, Entebbe, Jinja, Mbale and Masaka) will support 4 schools to update and disseminate messages on abstinence through student compositions of songs, poems, stories and art work. Although the previous work by other partners like PIASCY will be useful for this component, such messages need to be continually updated for more relevance in terms of content and medium as perceived by the youth themselves. This interactive upgrading of materials will allow for differences in perception by youths from different backgrounds thus resulting in more relevant and user-friendly messages. The supported schools will be those with functioning AIDS Challenge Youth Clubs (ACYC). This is an interactive youth-driven prevention programme involving several youths with personal or familial experience with HIV/AIDS. These youths base on their experience to mobilize their peers, seek technical support from TASO and reach out to fellow youths in families, schools and at-risk
communities. The schools to be supported are already identified and have ACYC clubs, but have skills gaps as they keep bringing new people on board and older members leave. ACYC activities during the school term will target in-school youths; and those during holidays will target out-of-school youths. The 5 TASO Centres will support ACYC club holiday activities involving 20 outreaches (i.e. 4 outreaches per each ACYC club operating at the Centre
The third AB component will be Staging PHA Drama Group Performances in the community. PHA Drama Groups in 8 Centres (Entebbe, Jinja, Mbale, Masaka, Masindi, Soroti Gulu and Rukungiri) will deliver messages and share knowledge with communities, schools, faith-based institutions and people in various other settings. These drama groups present vital HIV/AIDS information within the TASO, National and Global environment into songs, dances, plays and poems that simplify and clarify the messages for grassroots levels. PHA also give testimonials of personal experiences with HIV/AIDS (including issues like stigma, discrimination, human rights, gender inequality and others). TASO will conduct 400 AB-tailored performances reaching 100,000 people. TASO will also train 175 PHA (25 per each of the 7 Groups) in drama skills and message design on AB issues. In order to trigger off community and couple dialogue leading to reduction in HIV transmission TASO will: monitor more closely the message development and presentation for quality and effectiveness; undertake continual evaluation of drama practice/preparation sessions; access professional services in recruiting and training drama groups; ensure motivation/appreciation of PHA engaged in drama as key partners; and pay attention to geographical, social and cultural uniqueness to maximize relevance.
The fourth A&B component will be Community Capacity Building activities. TASO will support community-based HIV/AIDS programs in Jinja, Mbale, Eastern Region and South-Western Region. Community volunteers and service providers will be trained to conduct HIV/AIDS education tailored to AB in community venues such as village/parish/sub-county meetings, schools and funerals and places of worship. The community volunteers will reach 140,000 community members with HIV prevention campaign tailored towards AB. TASO will equip volunteers to appreciate and address gender issues pertaining to HIV infection and the higher vulnerability of women to infection. Reference to HIV testing services will also be made to mobilize community for HIV testing
This activity relates to Condoms and Other Prevention (8467), Counseling and Testing (8470), PMTCT (8466), Palliative Care: Basic Health Care and Support (8468), Palliative Care:TB/HIV (8469), Treatment: ART Drugs (8471), Treatment: ART Services (8472), Strategic Information (8474) and Laboratory Infrastructure (8473). The NUMAT project, which covers the sub regions of Acholi and Lango, was awarded in August 06 with FY 06 resources. Year 1 activities will be implemented over a 9 month period and will build on what has been achieved by other USG supported projects, including A A differentiated strategy is being implemented by the project in the two sub regions. In Lango, where the security situation is more stable and displaced people have begun going back to their homes, NUMAT will continue to support activities aimed at strengthening existing community and facility based HIV/AIDS/TB and malaria services. Services at static sites will be strengthened to meet the increasing demand by the returning population while other particular services will continue to be scaled up at lower levels of service delivery. In Acholi where conflict remains an issue and satellite camps are being created as the security situation stabilizes, efforts will continue being put on extending services to populations in camps particularly the peripheral camps. The project will continue working with a host of stakeholders including USG projects, UN, and humanitarian efforts, to scale up mobilization and service provision and referral for HIV/AIDS/TB and malaria services for the camp populations. The planned key achievements under this programme area in year 1 include reaching 212,000 individuals through activities that promote abstinence and/or being faithful, reaching 12000 school children with messages of HIV/AIDS prevention through abstinence and training 300 people to promote HIV/AIDS prevention through abstinence and/or being faithful. Year 2 activities will build on year 1 achievements and will include supporting children, youth, families and communities to build skills that promote sexual norms and behaviors, addressing Gender Based Violence by promoting family life education; engaging uniformed services, including military, police, and community security guards in programs to reduce SGBV and to prevent HIV by empowering communities to promote societal norms that reduce the risk of HIV transmission, strengthening protection "systems" and promoting the use of and access to HIV counseling and testing services. NUMAT will also support the review, revision and adaptation of other curricula, interactive materials, radio programmes and toolkits available in the country to make them suitable for the districts in Acholi and Lango regions. For out of school youth, HIV prevention messages will be linked to vocational training. The programme will link up with and help promote other effective prevention campaigns like the President's Initiative on AIDS Strategy for Communicating to Young People (PIASCY), Young Empowered and Healthy (YEAH) and ‘Be A Man' which seek to enhance the youth's ability to be responsible and to protect themselves against becoming infected with HIV.
NUMAT will also leverage resources from USAID's SO11 (Mitigating Causes and Consequences of Conflict). Protection resources to strengthen protection programs aimed at reducing HIV transmission. AGDA with Coca Cola and Christian Children Fund to establish access to safe water supplies is currently under review.
plus ups: Recognizing that final disposal of health care waste is one of the biggest challenges in medical transmission of HIV/AIDS, Plus up funds will be used to support the Ministry of Health to roll out the health care waste management policy in the 25 districts of operation. This activity addresses the final stage of the injection safety disposal process. Efforts will be put on establishing an environment where health workers, patients, and communities are better protected against transmission of blood borne pathogens. Health workers and waste handlers working on all USG funded programs like CT, Blood and injection safety, and laboratory services will be trained in proper disposal of used needles and syringes, and other health care medical waste like used blood transfusion sets, needle pricks, and laboratory waste. Such activities will include promotion of health worker safety related policies like immunization of health workers with Hepatitis B vaccine, establishing exposure management systems, and provision of waste management commodities and facilities. Additional funds will be used to develop waste management plans and support development of waste destruction facilities. Behavior change campaigns will be launched targeting communities and prescribers with the major aim of reducing unnecessary injections. All activities will e implemented in a manner that will offer men and women equal opportunity to access information and services.
This activity also relates to Abstinence/Be Faithful (8406), Counseling and Testing (8404), Palliative care: Basic Health Care (8405) and Palliative Care: TB/HIV (9058).
To date, 13,730 individuals reached through community outreach programs that promote HIV/AIDS prevention through other behavior change activities (beyond AB). 8 condom service outlets are currently targeted.
AIC will continue promoting HIV prevention activities and messages that focus on most at risk populations (MARPS) who are the "drivers" of the epidemic and are the heart of the GoU's new Road Map to Accelerated HIV Prevention . With a renewed focus to reach high risk and vulnerable populations, AIC will target sexually active youth in institution of higher learning, where transactional and cross generational sexual relationships occur most; fishing communities; IDPs and other mobile populations; uniformed forces; and discordant couples. AIC will reach these target audiences with appropriate IEC materials through HCT services and other community outreach activities such as MDD. In collaboration with MoH and AFFORD program involved in condom distribution, dissemination of information on correct and consistent use of condoms as well as consistent supply and availability of condoms will be a key intervention to be supported in coordination with other stakeholders.
AIC will work very closely with the targeted audiences to identify focal persons who will ensure that activities related to condom promotion including supplies are directed to highly mobile populations involved in increased casual sex with multiple partners. These persons will be trained and oriented in management of condoms, basic counseling skills on correct condom use and reporting on related activities. A total of 500 Condom distributors will be identified from various institutions of higher learning and trained in counseling for referral services and condom distribution. In addition couple clubs will be used as a channel for condom distribution during their monthly meetings. Appropriate IEC materials and other teaching aides will be procured to facilitate condom education. AIC will support approximately 175 condom service outlets. Approximately 570,400 people (male and females) will receive condoms.
Music Dance and Drama activities mainly through PTC members will be used to promote prevention BCC interventions. Some of the prevention BCC interventions will focus on substance abuse particularly alcohol consumption which increases risk of engaging in high risk behavior. In addition members of Philly Lutaya Initiative will also be supported to share with communities their life testimonies and experiences (PLI) in living with HIV and challenges of future prevention and coping mechanisms. The PLI will be complemented by the discordant couples club dialogues intended to promote behaviors that reduce the risk of transmission. Their performances and life testimonies respectively, will also encourage community dialogue activities related to HIV prevention, reduction of stigma and discrimination and prevention of gender-based violence in their communities.
This activity also relates to activities in Counseling and Testing (8433), Treatment:ART Services (8845),PMTCT (8434), Palliative Care: Basic Health Care and Support (8435), Palliative Care: TB/HIV (8431), Strategic Information (8436), Other Policy Analysis and Systems Strengthening (8838) as well as Abstinence/ Being Faithful (8437).
To date, 34 individuals have been trained to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful reaching 59,486 individuals. In Fy07, UPHOLD will continue to support interventions targeting most-at-risk populations in 28 districts excluding the Acholi-Lango sub-region where a new USAID funded project implementing HIV/AIDS activities among other interventions is slated to begin.
Recent findings have shown that high risk populations, such as commercial sex workers (among whom prevalence is thought to be as high as 50% and on the increase), long distance truck drivers, urban motorcycle riders (commonly referred to as ‘Boda boda' in Uganda), discordant couples, fishermen and the communities living at the landing sites, internally displaced persons and other mobile populations remain major pockets of HIV prevalence within the generalized epidemic in Uganda..
Through UPHOLD financial and technical support, Civil Society Organizations (CSOs) will continue to reach out to most-at-risk populations with HIV/AIIDS education, HIV counseling and testing as well as condom education and distribution services in collaboration with other key stakeholders such as the Ministry of Health and organizations involved in social marketing activities. Key commercial outlets existing in proximity to specified radius of lodges, nightclubs and bars (areas where high risk sex often takes place) will be targeted for condom distribution and with messages to raise awareness of and reduction in risky behaviors. A total of 500 condom service outlets will be targeted. Additionally, communities living near landing sites for fishing will be specifically targeted for prevention interventions mainly through support to CSOs to implement HIV/AIDS related activities in these high risk populations. Another key component of this activity relates to supporting HIV prevention interventions that aim at promoting responsible behaviors such as couple testing and mutual disclosure, as well as consistent and correct use of condoms among discordant couples and with casual partners. Supported CSOs will also focus on factors that are responsible for the low rate of partner disclosure, including stigma, and fear of a violent reaction, particularly by men against women. Training of CSO staff and community volunteers in issues and skills related to working with couples will be a key area of intervention. The community owned resource persons will be trained to undertake community based mobilization and education on gender based violence prevention and HIV/AIDS. All activities will aim at empowering communities and more so couples to promote societal norms that reduce the risk of HIV transmission and promote use and access to HIV counseling and testing services. UPHOLD will continue to provide support to CSOs in development and dissemination of IEC and behaviour change communication (BCC) messages and materials promoting and encouraging couples testing together, promotion of mutual disclosure and increasing awareness of discordance among couples. Prevention interventions among positives will bepromoted through PLHA network activities which will aim at increasing knowledge on the importance of partner testing, diagnosis of sexually transmitted infections (STIs), treatment and prevention, family planning and PMTCT. Regarding prevention of STIs, UPHOLD will support its partners to access existing MOH and AIM information to disseminate STI treatment guidelines and education on Herpes simplex type 2 virus (HSV-2) which is one of the factors closely associated with increased vulnerability to HIV infection. Sexually active youth who are mainly out-of-school will be reached with youth friendly services which will be supported to provide facility based and outreach counseling and testing, treatment, information,
entertainment and recreational services. A target of 5,000 community volunteers including staff from CSOs and most at risk population will be reached for training in different aspects and skills related to HIV sexual prevention.
This activity relates to Abstinence/Being Faithful (8456) , Palliative Care: Basic Health Care and Support (8454), Orphans and Vulnerable Children (8453), Strategic Information (8455) and Laboratory Infrastructure (8451).
To date, 89 service providers trained in other HIV/AIDS prevention (not AB) to reach 89,474 individuals through community outreach programs that promote HIV/AIDS prevention through other behavioral change activities (beyond AB). 11 condom service outlets targeted.
TASO will conduct prevention activities in line with the Uganda National Road-Map for HIV Prevention which aims at accelerating HIV prevention activities including reduction of sexual transmission of HIV, PMTCT, post-exposure prophylaxis, promotion of counseling and disclosure, protection of vulnerable populations, integration of HIV prevention into treatment and prevention of sexually transmitted infections. TASO had earlier on established HIV and STI prevention and these were running routinely as part of the overall services. In FY07/08, there will be special emphasis laid on all HIV/STI prevention activities and the enhancement of quality more than in the past. TASO will also assess prevention activities in terms of contributing to the targets of national roadmap and value-addition to the overall national response. Prevention AB messages tailored to address the HIV/AIDS challenges of specific target groups will be provided. Abstinence-tailored prevention messages will target children, adolescents, students, out-of-school youth and HIV-infected children. In addition under this strategy, the Be-Faithful-tailored messages will target sections of the general adult population deemed to be sexually active and so vulnerable to HIV infection.
The first Prevention-Other component will be Prevention with Positives. TASO is currently serving over 75,000 PHA and will undertake a deliberate effort to mobilize, sensitize and empower these clients into undertaking fresh commitment to contribute to preventing HIV infection in their households and communities. TASO will enhance partnership with PHA in HIV prevention activities. Prevention with Positives is also a new strategic approach that promises great potential because the PHA constituency forms the largest single stakeholder in HIV/AIDS. TASO will train 70 service providers at 7 Centres (i.e. Entebbe, Jinja, Mbale, Masaka, Masindi, Soroti and Rukungiri) to be able to provide supportive counseling to the PHA (including discordant couples) to enable them develop HIV prevention strategies beyond AB that work in their circumstances. Special focus on discordant couples will include establishment of Discordant Couples Clubs at the 7 Centers so as to support them in addressing challenging issues and adopting risk reduction plans. Support will also be given to clients enrolled on ART towards making risk reduction plans. The Strengthen Counselor Training in Uganda (SCOT) consortium will provide technical assistance to equip TASO counselors to support discordant couples and PHA in sexuality issues with an aim to have them contribute to scaling up prevention. Target will be people living with HIV/AIDS and discordant couples
The second component for prevention beyond A&B will be through conducting Drama Group Performances tailored towards prevention strategies beyond AB. TASO will train the 175 PHA involved in Drama Group activities in developing/adapting and delivering prevention messages tailored to strategies beyond AB such as correct and consistent condom use. The 8 PHA Drama Groups in Entebbe, Jinja, Mbale, Masaka, Masindi, Soroti Gulu and Rukungiri will conduct performances in communities through which they will reach 100,000 people through songs, dances, plays and poems. Target will be community - men and women plus people living with HIV
The third component of this activity will involve promotion of prevention strategies beyond A&B through Community-Based Programs. TASO will train/re-train 300 community
resource persons (volunteers) in promoting HIV prevention at community level. The community volunteers will provide prevention information beyond AB to 280,000 community members through organizing community HIV/AIDS education talks and drama performances by some communities with organized HIV/AIDS drama groups.
The fourth component for prevention activities beyond AB will be Provision of Condoms. TASO will operate condom service outlets located at the 11 TASO Centres and 40 community outlets located strategically in specified communities supported by the 11 TASO Centres. TASO staff will provide condom education and distribute condoms at the TASO Centres and volunteers in the communities. Condom distribution will be limited to adult and sexually active clients expressing need for strategies beyond AB. Target will be men and women plus people living with HIV including discordant couples.
Other sub-components under this activity will include mass media programmes aimed at behavioral change, condom promotion and reduction of stigma and discrimination; establishing peer support groups within communities to promote positive living and behavior change; and developing peer counseling skills among PHA. TASO will continue to collaborate with Ministry of Health and AFFORD program in the procurement and distribution of HIV/AIDS prevention commodities. Messages to clients on PMTCT and STI prevention will also continue.
This activity also relates to Abstinence/Being Faithful (8775), PMTCT (8466), Palliative Care: Basic Health Care and Support (8468), Palliative Care: TB/HIV (8469), Counseling and Testing (8470) , Treatment :ARV Services (8472), Treatment: ARV Drugs (8471), Laboratory Infrastructure (8473), Strategic Information (8474) and Other /Policy Analysis and System Strengthening (8475)
The NUMAT project, which covers the sub regions of Acholi and Lango, was awarded in August 06 with FY 06 resources. Year 1 activities will be implemented over a 9 month period and will build on what has been achieved by other USG supported projects, including AIM, UPHOLD and CRD. UPHOLD and CRD operations in the North are coming to an end next year.
In Acholi where conflict remains an issue and satellite camps are being created as the security situation stabilizes, efforts will continue being put on extending services to populations in camps particularly the peripheral camps. The project will continue working with a host of stakeholders including USG projects, UN, and humanitarian efforts, to scale up mobilization and service provision and referral for HIV/AIDS/TB and malaria services for the camp populations
The planned key achievements in year 1 include supporting 90 condom service outlets, reaching 550,000 people through community outreach that promotes HIV prevention through other behaviour change beyond abstinence and/or being faithful. Year 2 activities will build on year 1 achievements and will include promoting IEC/BCC activities in collaboration with community-based initiatives in the camps and villages. Together with the district teams, particularly the District Health Educators, HIV/AIDS radio programs will be expanded to cover all districts. Mobile audio-visual vans run by the MOH will be supported to reach IDP camps, and will complement existing activities, through CBO's, with music, dance and drama (MDD) shows. Support will also be provided to develop the most appropriate print materials in the local languages and also reprint relevant materials produced by AIM and other partners. These will include posters, leaflets, brochures, job aides, and flip charts in the local languages with messages promoting positive behaviors for the prevention of HIV infection, TB and malaria. Of particular interest will be messages regarding alcohol consumption and risk taking behaviors. Working with NGOs and CSO, as well as the UPDF to increase access to and demand for condoms, targeted messages for IDPs, sexworkers and uniformed officers will be developed, as well as determining best locations and distribution points for condoms. The project will also work with PHA groups to integrate condom messages and distribution into ongoing service provision activities. Screening for and promoting syndromic management of STIs will be integrated into Counseling and testing and palliative care services. This will include integrated training of health workers in management of STI and HIV/AIDS, support supervision of STI with HIV/AIDS activities, and supporting logistics for STI drugs including procurement of STI drugs, should situations of stock outs occur. STI clients will be referred to HCT within their treatment areas and through referral from lower units.
This activity also relates to Abstinence/Be Faithful (8406), Counseling and Testing (8404), Condoms and Other Prevention (8403) and Palliative Care: TB/HIV (9058 ).
According to the 2005 Uganda behavioral sero-survey, 79% of Ugandans don't know their HIV sero-status, due to various reasons which include limited access to HCT services. The survey also indicated that of the 8% of HIV positive individuals in Uganda, 40% of HIV sero-positive Ugandans in partnership with an HIV-negative spouse and most of these have never tested and do not know that they are living in a discordant relationship. AIC records show that clients have a high sero-prevalence (18%-19%) compared to national figure of 6.4%). AIC will continue to provide and increase access to HCT services that promote the integration of relevant and appropriate HIV/AIDS services, including palliative care, TB screening and management services to supplement services available within the network model.
The 7 AIC branches will continue to offer the following medical services through its medical staff and counselors: medical treatment for opportunistic infections (OI) and minor ailments; STD diagnosis and management; septrin prophylaxis; psychosocial support; and on-going counseling to all its clients. The treatment of OI is intended to reduce morbidity and mortality among HIV infected clients. Approximately 8,000 clients will be treated for OIs, and other minor ailments; 15,000 clients will be initiated on septrin prophylaxis. This will contribute towards national efforts of implementing government policy on scaling septrin prophylaxis and national guidelines on management of OIs among PHA.
In collaboration with other partners such as Population Services International (PSI), an estimated 700 HIV positive clients will be provided with comprehensive HIV basic care packages which include treated mosquito nets, water vessel guards, IEC materials on positive living and septrin prophylaxis all of which aim at improving quality of life of PHAS. The index HIV+ client will be encouraged to mobilize other family members and the community to access CT so as to identify infected clients in the home setting to allow early referral to care and treatment. AIC will refer clients that require ART and other care and support services beyond what they can offer to other agencies such as Joint clinical research Centre, TASO, Mild May and Regional public health facilities.
To be able to provide quality services to these clients, AIC will provide refresher workshops to 120 medical counselors on current issues in AIDS care and support, owing to the changing dynamics of HIV/AIDS as well as other legislative issues such as prevention of gender based violence .
This activity also relates to activities in Abstinence and Being Faithful (8437), Counseling and Testing (8433), Condoms and Other Prevention (8432), PMTCT (8434), Palliative Care: TB/HIV (8431), Strategic Information (8436), Other/Policy Analysis and Systems Strengthening (8838) as well as Treatment:ARV Services (8845).
Achievements to date: 32 outlets are providing HIV related palliative care (excluding TB/HIV) reaching 3,525 individuals. 138 individuals have been trained to provide HIV palliative care (excluding TB/HIV).
Despite increased resources from PEPFAR, Global Fund, the World Bank and other funding agencies there are still considerable gaps in access to palliative care. A limited number of people living with HIV/AIDS have access to palliative care services out of an estimated 800,000 in need. Therefore, increased access to palliative care remains a priority to which UPHOLD will continue to contribute in the nation's response to HIV/AIDS pandemic.
One key component of this activity is to continue providing comprehensive care and support to PLHA in 28 districts (including 8 that were formerly shared with the just concluded AIM program and the newly gazetted districts). UPHOLD will provide funds to both public and private health facilities to strengthen the delivery of comprehensive and integrated clinical services within the network model. Key areas of focus of clinical integrated services will include management of malaria/STIs and TB; provision of cotrimoxazole prophylaxis and post exposure prophylaxis (for health workers); pain management and symptom control and terminal and spiritual care outside the facility. UPHOLD will work with other partners such as Hospice Africa Uganda to rapidly roll out of this component through hospitals and Health Centre (HC) IVs in partner districts. 25,000 people living with HIV/AIDS will be targeted under this activity. 250 service providers from 145 public and private health facilities will be trained to provide the services mentioned above. On job training and support supervision to health workers will be provided.
As part of this activity, UPHOLD will leverage PMI resources for net retreatment; collaborate with AFFORD to facilitate access to socially marketed nets within the private setting.
Through UPHOLD supported civil society organizations, a family approach to delivery of palliative care services will be promoted. Utilizing the index HIV+ client as an entry point into the family and community, home based carers will have an opportunity to offer counseling and testing to spouses, children, orphans and other vulnerable children and assess them for prompt care, support and referral. To facilitate the delivery of services, home based carers will be provided with home based care kits. UPHOLD supported CSOs have already trained community workers who provide home based care services and are therefore able to implement and sustain this family approach. Various community based structures including post-test clubs, psychosocial support groups for HIV+ mothers and spouses, religious leaders, faith-based organizations and volunteers have been mobilized and will be trained and engaged in delivery of care and referral at community level. In collaborations with other stakeholders, these community volunteers will also address legislative issues including, stigma, discrimination and gender based violence An estimated 1,000 volunteers will be trained to support the services mentioned in this paragraph. The existing links between the health units and community support groups will also be strengthened through community volunteer interventions to ensure effective referral and follow up for PLHA. Effective referral and follow up will be enhanced through collaboration with the new PHA Activity. These linkages are particularly necessary for people receiving HIV/TB treatment and anti-retroviral therapy to ensure adequate support for treatment
A component of this activity will focus on community mobilization activities to promote positive behaviors such as: gender equity; couple dialogue; partner counseling and testing; disclosure; and accessing treatment together. Community mobilization activities will also be directed towards elimination of negative behaviors that bring about stigma and discrimination associated with HIV/AIDS. UPHOLD will continue the support to strengthening/setting up of PLHA networks through training and logistics support in 28 districts of Uganda. PLHA networks will increase community mobilization, address stigma, denial and discrimination among PLHAs and their communities, and facilitate referral for treatment. This support is expected to increase the overall capacity of PLHA networks to access additional funding opportunities.
This activity also relates to Abstinence/ Being Faithful (8456), Condoms and Other Prevention (8452), Orphans and Vulnerable Children (8453), Strategic Information (8455) and Laboratory Infrastructure (8451).
Achievements to date: 130 individuals trained from 11 service outlets to provide palliative care: basic health care and support for HIV infected people thus reaching 65,005 individuals.
This activity will provide basic health care and support to an estimated 40,000 clients and 10,000 family members served through 7 TASO centers viz Jinja, Mulago, Mbale, and Masindi, Rukungiri and Soroti and their outreach clinics. Basic health care and support will include clinical care services, psychosocial support, social care and support and linkages to referral networks. Under clinical care services TASO, through 7 centers and 29 outreach clinics, will provide ongoing post-test counseling, Opportunistic Infection management, STI diagnosis and treatment, family planning, PMTCT support services (through counseling and referral for services), nutritional counseling and education, pain relief, ongoing assessment for ARV readiness and support services to ART adherence. Under psychosocial support, TASO through counselors and community support groups at the 7 centers and 34 outreach clinics will provide support for disclosure of serostatus to partners, will-making and bereavement. Approximately 200 counselors will receive refresher training on emerging issues like discordance, positive prevention, adherence to ARV regimens and couple counseling.
Under social care and support, TASO through community mobilization and community support groups, will provide psycho- social support to HIV-infected individuals and their families and promote maintenance of linkages to and use of healthcare services and the reduction of stigma due to HIV/AIDS.
TASO will maintain strategic linkages with partners engaged in nutritional support, sustainable livelihoods programming and economic empowerment of PHA. TASO will seek to renew the MOU with WFP likely to support 44,244 PHA and family members. TASO will seek to participate in the new ACDI/VOCA multi-year activity plan that will provide nutritional support to PHA registered with TASO Soroti, Lira Mini-TASO, TASO Gulu and Mini-TASOs in the Acholi sub-region.
TASO will continue to collaborate with partners in HIV/AIDS care that include 8 Mini-TASO and 10 CBO. Through USAID FY07/08 funds TASO will support the activities of Mini-TASO/CBO in the Eastern Region, namely Kaberamaido Mini-TASO, Pallisa Mini-TASO, KASO-Kumi and KASO-Kapchorwa; and Mini-TASO/CBO in the South-Western Region, namely Kabale Mini-TASO, Kasese Mini-TASO, Virika Hospital and Sembabule CBO. TASO will grant US$ 33,333 for Mini-TASO/CBO in Eastern region and US$ 67,500 for those in South-Western region. Mini-TASO/CBO will be engaged in Prevention Other and Palliative Care: Basic Health Care and Support activities. These partners are supported to provide HIV care and support services through adoption of the TASO model of HIV care including involvement of PLWAs, psychosocial care plus set up of HIV M&E system
This activity also relates to Abstinence/ Being Faithful (8775), Condoms and Other Prevention (8467), PMTCT (8466), Palliative Care: TB/HIV (8469), Counseling and Testing (8470),Treatment :ARV Services (8472),Treatment: ARV Drugs (8471), Laboratory Infrastructure (8473), Strategic Information (8474) and Other/Policy Analysis and System Strengthening (8475).
NUMAT will also work in close collaboration with all of the key stakeholders supporting the North including the GOU, local government political and technical officials, UN agencies, humanitarian organizations, local faith and community based organizations and USG supported activities. Specific organizations working on palliative care include international NGO efforts to support home-based care and key USG supported activities.
The planned key achievements in year 1 include: building and strengthening the capacity of all hospitals and HCIVs to offer basic palliative care and reaching big camps with basic palliative care.
Year 2 activities will build on year 1 achievements and will include : supporting the scaling up of Basic palliative care services to lower health units and camps in the periphery. The project will coordinate closely with the USAID supported PHA initiative to support PHAs and their families to increase access to and use of appropriate, well supported and supervised palliative care services. The project will work through and strengthen PHA networks, health facilities, CBOs and Community Care Coalitions (CCC) to strengthen and expand home and community care services and strengthen the referrals/networks for those individuals who require clinic based care. The project will support access to preventive care services including septrin prophylaxis for opportunistic infections (OIs), peer psychosocial support, communications for prevention among positives, condoms, and linkages to wrap around services including food, material support, and family planning. ITNs will be comprehensively provided to all districts in the north in FY06 and FY07 through PMI. Community and home-based care (HBC) organizations and community volunteers will be strengthened to serve as the primary providers of critical services. The project will coordinate with and leverage other USG supported initiatives IRCU, AFFORD, PSI and the Expanding of PHA network project to reach more PHAs with basic palliative care services.
Logistics systems will be supported through training and mentoring in collaboration with SCMS and Deliver II.
In the Lango sub region, PHA networks are more functional as a network and will continue to be strengthened. In the Acholi sub region PHA groups have been fragmented through donor support. This activity will seek to strengthen and consolidate PHA groups and networks within camps and across districts.
This activity also relates to activities in Abstinence and Being Faithful (8437), Counseling and Testing (8433), Condoms and Other Prevention (8432), PMTCT (8434), Palliative Care: Basic Health Care (8435), Strategic Information (8436), Othe/Policy Analysis and Systems Strengthening (8838), as well as Treatment :ARV Services (8845).
Achievements to date: Number of service outlets providing clinical prophylaxis and/or treatment for TB for HIV infected individuals is 28 through which 748 individuals have been reached with HIV care/treatment services for TB treatment. 491 individuals have been trained to provide clinical prophylaxis and/or treatment from Tb to HIV infected individuals (diagnosis or presumed).
TB National Reports (2005) indicated that Uganda had only achieved 50.2 % case detection rate of new smear positive TB and 70.4% treatment success rate; which is still below the global case detection and treatment success rates of 70% and 85% respectively. Delays in drug procurement and distribution, shortage of health personnel, inadequate diagnostic capacity and lack of support supervision are some of the reasons that account for this low performance.
UPHOLD will continue to support interventions to increase case detection and treatment success rates for TB. One of the main components of this activity is to continue providing financial and technical support to local government and CSO heath units to provide integrated HIV/TB prevention and treatment services. Activities will focus on increasing facility capacities in patient care and improving clinical settings and systems. The estimated target of HIV/TB patients to be reached is 5,000 in 28 districts (including 8 that were formerly shared with the just concluded AIM program and the newly gazetted districts).
On site technical support and mentoring on TB/HIV integration will be provided to health workers to improve their competencies in TB/HIV diagnosis and management including pediatric TB/HIV, internal and external referrals for support counseling and ART for eligible individuals, logistics planning and TB/HIV reporting. The facility-based HIV/TB management will focus on improving systems for screening both TB patients for HIV and HIV positive clients for TB. UPHOLD will undertake to distribute and disseminate national guidelines on TB/HIV to all the supported health units in support of implementation of the TB/ HIV policy and communication strategy. Through routine HIV counseling and testing services, the supported public and private health facilities will establish mechanisms to identify, diagnose and treat TB infection in children and adults leveraging training and resource material sharing from the Infectious Diseases Institute and other relevant partners. An estimated 250 service providers from 145 service outlets will be targeted.
Community involvement in HIV/TB prevention and care will be an important focus area. Leveraging USAID infectitious disease TB resources, interventions will be scaled up through training of CSO staff and volunteers in the provision of community based directly observed tuberculosis treatment (CB-DOTS). This intervention will increase TB prevention and treatment literacy among PLHAs, some of whom will be utilized as ‘expert clients' to follow up and counsel their peers on TB treatment The trained community volunteers will conduct community dialogue sessions under this component to educate communities about TB and its relationship with HIV as well as the importance of its early diagnosis, prevention and prompt treatment. Through functional linkages with PLHA networks and referrals of HIV/TB clients to ART services, TB and Antiretroviral treatment outlets will be strengthened through the provision of information on service outlets during community health talks and fellowship meetings. In addition, the PLHA networks will promote other referrals such as provision of food supplementation supplied by the WFP program through
agencies like TASO, Catholic Relief Services and World Vision. Behavior change communication activities which include clear and comprehensive messages for individuals, families, communities and PLWAS with TB will be funded through the CSOs to address TB and HIV care and support and community education on TB will mainly be done through infotainment. The community mobilization activities will aim at reducing stigma associated with HIV status; demystifying stereotypes on norms about masculinity that promotes early sexual activity and multiple sexual partners for boys and men; increasing the equitable number of women who are receiving treatment; and mitigating the burden of care on women and girls by linking care programs with community efforts that provide resources. As part of the mobilization campaign, UPHOLD will also build on radio programs formerly supported by the AIM program.
This activity also relates to Abstinence/ Being Faithful (8775), Condoms and Other Prevention (8467), PMTCT (8466), Palliative Care: Basic Health Care and Support (8468), Counseling and Testing ( 8470), Treatment :ARV Services (8472), Treatment: ARV Drugs (8471), Laboratory Infrastructure (8473), Strategic Information (8474) and Other/Policy Analysis and System Strengthening (8475).
NUMAT will also work in close collaboration with all of the key stakeholders supporting integrated TB/HIV in the North including the National TB and Leprosy Program, local government political and technical officials Gulu Independent and Lacor Hospital, CDC, WHO, AVSI, CUAM, Malaria Consoritum, CBOs, and GLRA on TB activities as well as USG supply chain efforts DELIVER II and SCMS.
The planned key achievements in year 1 include: leveraging USAID infectious disease TB resources to scaling up and strengthen CB-DOTS in the majority of the sub counties / camps and initiating TB/HIV collaborative activities in Acholi sub region and strengthening those in Lango sub region.
Year 2 activities will build on year 1 achievements and will include working with district health officials to identify community and camp members to be trained as sub county health workers and develop appropriate supervision systems for volunteers who administer drugs. Community health workers will be trained to play the role of sub-county TB supervisors. Working with the district health officials, trained volunteers will be facilitated with transport in form of bicycles, to do their work. Building on earlier efforts by AIM, community education efforts that provide simple messages about TB symptoms and the importance of early detection and complete cure as well as IEC/BCC activities to sensitize and mobilize communities on TB will be supported. Simple health worker tools to more easily screen patients who present with coughs will be developed. Re- training and routine supervision of laboratory health workers will be supported to improve sputum smear examination through
Increasing the number of diagnostic units through support to mobile laboratories serving lower levels of the health system.
Training non laboratory medical personnel (e.g. nursing assistants) as microscopists.
Providing logistical support to assure drugs and other supplies are secure and reach health units in time.
Documenting and disseminate lessons learned.
NUMAT will provide support to the zonal TB officers to provide supervision.
HIV/TB collaborative activities will focus on ensuring TB patients are referred and tested for HIV and HIV patients are referred and screened for TB. In keeping with the national priorities support at the district level will include supporting joint planning for HIV and TB as well as district coordination structures, training health workers in HIV/TB collaborative activities, providing registers which cater for both TB and HIV activities and facilitating support supervision. Integrating co-trimoxazole prophylaxis and ART into Tb care will also be strengthened within health facilities. Community activities supporting PHAs and TB patients will also be strengthened to effectively integrate education, awareness, advocacy and referral for TB and HIV re spectively.. This will be done through training
This activity relates to Abstinence,Being Faithfu (8456)l, Condoms and Other Prevention (8452), Palliative Care: Basic Health Care and Support (8454), Strategic Information (8455) and Laboratory Infrastructure (8451).
Achievements to date: 11 service outlets providing support to reach 11, 210 OVCs. 16 service providers trained in handling OVCs.
TASO has developed a Child Services Strategy that re-packages the services that TASO previously offered to OVC according to the principles and guidelines of the National Strategic Programme Plan for Implementation of OVC activities (NSPPI) and the National Orphans Policy (NOP). Liaison with the OVC Secretariat at the Ministry of Gender, Labor and Social Development (MGLSD) that authored the NSPPI and NOP will be maintained for policy support towards improving the TASO child services strategy. Technical support of child programming is and will continue to be sought from UNICEF. TASO will also seek opportunities to refer some OVC for support to other child-oriented agencies since the current number of needy children is beyond the anticipated resource envelope and also child needs are diverse.
One of the components of this activity is the educational program for children infected and/or affected by HIV/AIDS in both primary and secondary schools. Biological children of TASO clients or child clients themselves will be supported on the basis of being very needy and not benefiting from any other program. This component provides school fees for both primary and secondary school going children, boarding fees for those in secondary schools, uniforms and stationary items in 4 of its service centers. A total of 500 pupils in primary and 500 students in secondary schools are targeted to benefit under this component.
The second component of this activity is the life skills training workshops. The target group is 14-17 year olds who can read and write. It is aimed at providing means of self-development and skills to promote HIV prevention. The target will be 2000 children reached through the ACYC clubs in schools. Target will be school children and out of school youth
The third component of this activity will be training of providers/caretakers with skills in the areas of food and nutrition, and psychosocial support. The target group will include parents and guardians of OVC. Quarterly workshops will also be held to coordinate OVC activities and provide new information to TASO staff concerning care for OVC and orientation of community workers in child counseling.
Counseling and medical support will be provided to orphans and vulnerable children enrolled as TASO clients under this activity. This is estimated to include 4,000 children. The services provided include child counseling, treatment of opportunistic infections and home care. The area however excludes provision of ARVs which is covered under the CDC budget. Wrap round services will also be a focus to provide skills to OVC, parents and guardians
This activity also relates to Abstinence/Be Faithful (8406), Condoms and Other Prevention (8403), Palliative Care: Basic Health Care (8405) and Palliative Care: TB/HIV (9058).
AIDS Information Centre-Uganda (AIC) is a Non-Governmental Organization established in 1990 to provide the public with Voluntary Counseling and Testing (VCT) services on the premise that knowledge of ones own sera-status is an important determinant in controlling the spread of HIV. AIC also uses HCT as an entry point to HIV/AIDS service-provider initiated services including prevention of HIV transmission, treatment of opportunistic infections, PMTCT services and ART referrals and other care and support services. In FY 07 AIC will continue contributing towards the national efforts of decreasing the 79% of people living with HIV/AIDS who do not know their HIV aerostats (Uganda Behavioral sero-survey 2005).
Achievements to date: 262 service providers trained in counseling and testing according to national standards from 170 functional HCT outlets to reach 120,503 individuals who have been counseled, test and received results.
In FY 07, AIC will support MOH to scale up the implementation of Routine counseling and testing (RTC) a new government policy on HCT. AIC in collaboration with MOH will provide counseling and testing services to 56 public hospitals and Health centers IVs. These services will target in inpatients that include men, women and children coming to seek other health services. It is expected that 10,800 people will receive counseling and testing services from the RTC approach. AIC will continue to provide counseling and testing services to clients at 7 main branches (this excludes districts falling within the new Northern Uganda Malaria, AIDS & TB project).
In FY 07, AIC will scale up activities targeting couples by introducing free HIV testing and counseling on specific days, increasing couple clubs from the 4 existing ones to 7 and providing training in key communication skills and prevention of gender based violence among couples. Discordant couples clubs will provide psychosocial support to help members cope with HIV discordance and disclosure, sharing of personal testimonies, promotes and advocate for the benefits of couple testing and receiving results together with the general community. All these interventions are aimed at increasing HCT service uptake and access to couples as well as addressing issues of non disclosure related to discordant results. It is estimated that 30,000 couples will be reached with HCT in this funding period.
Another component of this activity is increasing youth access to HCT services. Funding will be used to scale up HCT services to reach more youth by adding youth centers in the other AIC branches. Youth will be encouraged through AIC led Radio programs, Post test club activities in the community to participate in AIC - Youth activities. Youth friendly services and activities be supported include education talks on STIs as well as treatment and responsible sexuality, Family planning services, Life skills training, specific training in prevention of gender based violence, and basic income generating skills. It is estimated that 39,500 youth both in and out of school will be targeted in this funding period.
AIC will scale up its strategy of increasing access of HCT services to Most At Risk Populations(MARPS) who include fishing communities, commercial sex workers uniformed personnel and sexually active youth in higher institutions of learning. Through increasing HCT outreaches and community mobilization activities led by PTCs, fishing communities will be mobilized for HCT services during specific days of the week. AIC counselors and medical staff will be available at the targeted landing sites on the agreed days and time to provide education on HIV/AIDS, family planning, STI information and TB screening through providing counseling and testing to individuals and couples. The number of landing sites that AIC will provide HCT services will increase from 5 to 10 in FY 07. It is estimated that a total of 7,800 people in fishing communities will be reached with HCT services in this funding period. Commercial sex workers (CSW) are another group at risk that AIC will increase its focus for HCT services. In collaboration with AMREF in Kawempe division , AIC will continue to provide HCT services as well as training of peer educators among CSWs, who will reach out their fellow peers in lodges and brothels with information and condoms and well as encouraging them to access HCT services. In towns of Kampala, Jinja, Mbale and Mbarara mobilization and HIV/AIDS education activities for lodge and bar
owners will be increased and counselors will reach out to the private places provided by lodge owners to provide HCT services to CSWs. It is estimated that 4,300 CSWs will be reached with HCT services. Uniformed personnel will also be reached with HCT services provided by each AIC branch. The uniformed personnel include police and prison services, private security firms and army detaches in the field that are not directly covered by the UPDF medical services. A total of 2,000 uniformed personnel will be reached with HCT services. AIC procurement of test kits is largely for AIC branches and their supported sites, but also functions as a back up to their National system in case of acute short outs.
OGAC Reviews: Please clarify Activity 8404 (AIC) - There are 1229 people targeted for training, but no mention in the narrative.
We will update the COP. For information an estimated 1,229 service providers for AIC and partners will receive training and appropriate support supervision to meet the increasing demand for counseling and testing services. Personnel to be trained include 541 counselors, 176 lab technicians, 152 HCT Supervisors and 360 HCT service providers.
plus ups: As part of AIC's support supervision at its branches and in several Ministry of Health sites providing CT, AIC will partner with MOH, particularly the Quality Assurance Unit, the HIV rapid testing training coordination unit at CPHL/UVRI and district-level laboratories to implement the quality assurance plan from the MOH. Support supervision through external quality assurance will include monitoring of adherence to set quality CT standards, identifying personnel for training in rapid testing, use of finger stick technology for non-laboratory staff by the appropriate partner, promotion of post test counseling and managing referrals.
This activity also relates to activities in Abstinence and Being Faithful (8437), PMTCT (8434), Condoms and Other Prevention (8432), Palliative Care: BasicHealth Care and Support (8435), Palliative Care: TB/HIV (8431), Strategic Information (8436), Other/Policy Analysis and Systems Strengthening (8838) as well as Treatment: ARV Services (8845).
Achievements to date: 98,980 individuals have been counseled, tested and received results; 165 individuals have been trained in counseling and testing according to national standards; and 404 HCT service outlets are providing HCT services.
According to the 2005 Uganda HIV/AIDS Sero-Behavioural Survey 2004-05, 79% of HIV-positive Ugandans do not know their HIV sero-status due to various reasons including limited access to HIV counseling and testing (HCT) services. This funding will assist UPHOLD to contribute towards increasing accessibility to HCT services particularly among the rural poor and hard-to-reach high risk populations including the fishing communities, internally displaced persons, motorcycle drivers in major town centres (commonly known as ‘Boda boda' in Uganda) and out-of-school youth. Home-to-home and family-based HIV counseling and testing will be utilized. Additionally, individuals will be encouraged to test through testimonials by those who have tested. Counseling and testing will be implemented in 28 districts (including 8 that were formerly shared with the just concluded AIM program and the newly gazetted districts). A key target for FY07 is to provide integrated HCT services to 150,000 individuals. This target is expected to be achieved through supporting partners including 35 CSOs, 215 static sites including hospitals, HC IV and HC III including 100 formerly supported by AIM, and 40 new private-for-profit clinics), and a total of 285 outreach outlets. Outreaches will prioritize locations near high activity areas like communal markets, landing sites for fishing communities, camps for internally displaced persons (in Katakwi district), tertiary institutions and trading centres. UPHOLD will transition out of the North in FY07 with the start up of the new Northern Uganda Program.
Another component of this activity includes training of health service providers such as counselors, laboratory staff, and data assistants to support the roll-out of the new routine counseling and testing (RCT) policy in UPHOLD supported health facilities(both public and private).Training activities will mainly focus on strengthening counseling skills, logistics and records management, laboratory services, referral and general patient care with an aim of improving provision of integrated HIV counseling and testing/tuberculosis and sexually transmitted infection service delivery mainly targeting pregnant women, couples, patients with TB symptoms and children born to HIV+ positive mothers. A total of 750 personnel will be trained.
In order to strengthen the planned activities, there will be increased support for and utilization of post test services through post test clubs (PTCs) and promotion of awareness about discordance and disclosure. People living with HIV/AIDS (PLHA) networks and PTCs will be strengthened by providing them with counseling and advocacy training so that they can effectively engage in peer psychosocial support, community mobilization activities and link PLHAs to care and treatment services. Couple counseling and testing will be promoted through use of ‘model couples' in PTCs and information, education and communication activities. Prevention of gender based violence (GBV) will also be supported by training and conducting support supervision of all the CSOs and supporting them to conduct action oriented community dialogue on GBV issues. The training and the post training support supervision that will be provided to public heath units, CSOs and private clinics will principally aim at building the capacity of existing institutions, supporting sustainability and harnessing the synergies of the private and public sectors and enhancing inter-sectoral co-ordination and referrals for other HIV/AIDS services.
An additional component of this program area will focus on increasing awareness about use and benefits of HCT services through targeted and participatory community mobilization interventions which will mainly be channeled through local communication outlets such as local theatre/drama groups. The key legislative areas to be addressed include issues of gender equity and prevention of gender based violence, stigma and discrimination, denial, routine counseling and testing, couple dialogue and counseling and testing together, male norms about masculinity, early marriages, multiple sexual partners and transactional sex as well as linkages to other prevention, care and treatment services.
This activity also relates to Abstinence/Being Faithful (8775), Condoms and Other Prevention (8467), Palliative Care: Basic Health Care and Support (8468), Palliative Care: TB/HIV (8469), Counseling and Testing (8470) , Treatment :ARV Services (8472), Laboratory Infrastructure (8473), Strategic Information (8474) and Other /Policy System Strengthening (8475).
NUMAT will also work in close collaboration with all of the key stakeholders supporting the North including the GOU, local government political and technical officials, UN agencies, humanitarian organizations, local faith and community based organizations and USG supported activities. Organizations specifically supporting CT include the Military, UNICEF and PSI.
The planned key achievements in year 1 include: Building and strengthening the capacity of all hospitals, HC1V to offer HCT services including RHCT. Outreaches to camps beyond the municipalities will be supported through HCIVs and HC3's where capacity existis.
Year 2 activities will build on year 1 achievements and will include: working closely with central and local governments (MOH), CSOs and the private sector, to develop HCT services tailored to individual, family and community needs and expectations and to most at risk populations, particularly uniformed services, IDPs, and commercial sex workers. The project will emphasize scaling up HCT services to reach peripheral communities, especially those in IDP camps.
HCT promotion and community mobilization will focus on IDPs, military and commercial sex workers. IEC/BCC materials will be translated and/or adapted for relevant languages and cultures. Post test clubs will be supported at each health unit providing HCT as well as in all camps that do not currently have such groups. Each PTC will be supported to: sensitize and mobilize key populations to access HCT, offer ongoing counseling to members through trained psychosocial support counselors, offer regular educational talks and recreation, and train peer educators. Activities in the first year include conducting PTC needs assessments, feed back meetings, planning meeting and equipping the new PTCs.
The project will implement a variety of complementary service delivery models, including
RHCT in established health units, integrated outreach including HCT, and other innovations that meet the needs of IDPs and returnees. For RHCT, hospitals, HC IVs and IIIs, will be strengthened to develop systems that target the most at-risk clients including those on medical wards presenting with STIs and TB. NUMAT will also scale up HCT to selected level HC IIIs. Hospitals and HC IVs with sufficient human capacity will be supported to conduct at least two integrated outreach efforts per month. These will be initially to HC III facilities that do not have the capability to offer these services. This scenario will be promoted more in the Lango region where most of the IDPs are back in their communities and can access services at HCIII. The project will train staff with a focus on couples counseling and pediatric testing, perform modest rehabilitation, equip laboratories and form alliances with CBOs to provide counseling and referral to static and outreach sites. In Acholi, where possible, outreach will be done in HCIII. However since most of the population is living in peripheral camps and far from health centers, we will offer confidential services in temporary structures such as mobile tents. Mindful of the rapidly evolving situation, the project will also quickly begin working with existing HCIII in Acholi so that as people return to their homes, services will be available.
Logistical support will be provided by regional offices and will work in partnership with SCMS and Deliver II to support the pull system and to strengthen capacity in lower level facilities, including training and mentoring of health workers, forecasting and delivery of test kits and related commodities.
Referrals to care and support will be facilitates to ensure that those tested can access a wide range of services including wrap around services. PTCs and PHA groups will act as one avenue for this. However, referral mechanisms will be developed (or strengthened where e existing) suitable for specific intra facility referrals and also within a given geographical area.
This activity also relates to Abstinence /Being Faithful (8775), Condoms and Other Prevention (8467), PMTCT (8466), Palliative Care: Basic Health Careand Support (8468), Counseling and Testing (8470), Laboratory Infrastructure (8473), Strategic Information (8474) and Other/policy Analysis and System Strengthening.
In Acholi where conflict remains an issue and satellite camps are being created as the security situation stabilizes, efforts will continue being put on extending services to populations in camps particularly the peripheral camps. The project will continue working with a host of stakeholders including USG projects, UN, and humanitarian efforts, to scale up mobilization and service provision and referral for HIV/AIDS/TB and malaria services for the camp populations.
The planned key achievements in year 1 include: Procurement of ART through an agreed upon system by NUMAT and USG. USG is likely to recommend services for procurement of ART drugs for northern Uganda.
The key activity for year 2 will be to continue the procurement of ARVs through the agreed upon systems and deliver the drugs to the districts, facilities, camps and any other treatment area that have been accredited.
This activity also relates to Abstinence/Being Faithful (8775), Condoms and Other Prevention (8467), PMTCT (8466), Palliative Care: Basic Health Care and Support (8468), Counseling and Testing (8470), Laboratory Infrastructure (8473), Strategic Information (8474) and Other Policy Analysis System Strengthening (8475).
The NUMAT project, which covers the sub regions of Acholi and Lango, was awarded in August 06 with FY 06 resources. Year 1 activities will be implemented over a 9 month period and will build on what has been achieved by other USG supported projects, including AIM, UPHOLD and CRD. UPHOLD and CRD operations in the North are coming to an end next year. A differentiated strategy is being implemented by the project in the two sub regions. In Lango, where the security situation is more stable and displaced people have begun going back to their homes, NUMAT will continue to support activities aimed at strengthening existing community and facility based HIV/AIDS/TB and malaria services. Services at static sites will be strengthened to meet the increasing demand by the returning population while other particular services will continue to be scaled up at lower levels of service delivery. In Acholi where conflict remains an issue and satellite camps are being created as the security situation stabilizes, efforts will continue being put on extending services to populations in camps particularly the peripheral camps. The project will continue working with a host of stakeholders including USG projects, UN, and humanitarian efforts, to scale up mobilization and service provision and referral for HIV/AIDS/TB and malaria services for camp populations The planned key achievements in year 1 include: Increasing the number of accredited facilities that offer ART and providing services to 1000 individuals. Year 2 activities will build on year 1 achievements and will include addressing the specific constraints facing the ART programme in the project area. In the NUMAT project area , the roll out of ART programs has been slower than in the rest of the country due to the ongoing armed struggles, the highly mobile and fractured lives of PHAs and the precarious transport routes that make continuous access to care and drugs challenging.
To address this, NUMAT will directly target PHA and families, especially HIV-positive children, pregnant women and their families, PHA with TB, and PHA from medical wards to increase their access to ART efforts underway in the region. The project will work with health workers, community volunteers and the wider community to reach target populations. There are a number of critical areas that the project will provide much needed support including:
Increase access to ART by establishing ART sites at all district hospitals, accredited private health facilities and some HC IVs not currently served by other USG or other donor efforts. Assessment and capacity building of more ART sites will be done. Training and site support will be prioritized based upon those skills and areas that are critical for initiating ART programs. Examples of supported activities include: health worker and "treatment supporters" in-service training, collaboration and creating linkages with other projects to ensure that appropriate ARVs are in stock; provision of ARVs, strengthening existing distribution systems to ensure ARVs are continuously available in the supported sites, developing site-specific standard operating procedures, job aids, or data management training. Where possible, ART clinics will be fully integrated into HIV care where clients are initially screened and registered before they begin ART. Where integration of ART into existing HIV care centers is not an option, we will promote use of MOH's chronic care register to link up clients to the closest available ART site.Collaboration with the MOH, SCMS and DELIVER and others to, rapidly scale up logistic systems to ensure uninterrupted access to ARTs.
Create community awareness about HIV treatment and support efforts to create a community culture of treatment literacy.
Establish client-centered referral systems that link ART clinics to facility and community based programs to facilitate linkages with PMTCT and HCT sites, TB clinics, post-test clubs, and PHA support services. Referral forms will be developed so that clients can more easily navigate between service delivery sites. Integrated outreach to camps will
include follow up of PHA on ART to provide adherence support as well as routine re-supply of drugs Foster innovative, client centered ART adherence programs like personal communication equipment (walkie-talkies, mobile phones) to PHA treatment supporters/ expert clients to link them to treatment sites.
Make pediatric ART a priority. Children living with HIV present a unique challenge, particularly in the North. The project will work with partner organizations to develop simple tools to identify infants and children who may be living with HIV but are not in care and refer them for testing and possible care to build partnerships with other ART USG funded projects in the area.
OGAC Review: UPHOLD - 8472 - establishing ART sites in "all district hospitals" - please clarify.
This activity is the NUMAT, Northern Uganda activity. The program will focus on selected districts in the conflict districts where there are identified needs for treatment services.
This activity also relates to activities in Counseling and Testing (8433), Condoms and Other Prevention (8432), PMTCT (8434),Palliative Care: Basic Health Care and Support (8435) , Palliative Care: TB/HIV (8431), Strategic Information (8436), Other/Policy Analysis and Systems Strengthening (8838) as well as Abstinence and Being Faithful (8437).
In collaboration with other stakeholders including the Ministry of Health, UPHOLD will support the printing, dissemination and utilization of information, education and communication (IEC) materials on antiretroviral therapy (ART) to be used by community based workers in the UPHOLD districts. The community based workers will be able to use the IEC materials in the promotion of community awareness and education about the ART program and services. Other activities that supported CSOs will implement will focus on working through local administrative structures such as the Local Councils (LCs) and the UPHOLD initiated Community Radio Listening Clubs to disseminate information related to adherence to ART and other treatment (e.g., TB medication); drug resistance and its causes and how to avoid it; the importance of proper nutrition; responsible sexuality (including prevention of super infection and infection of others) and positive living strategies for PLHAs.
UPHOLD will continue to support information dissemination and increase ART literacy programs to the general communities through strengthening PTCs to encourage CT access and utilization thereby opening up access to treatment and care for those who are HIV+. The PTCs will also link up the PMTCT mothers' clubs to encourage adherence for the clients already on ART. Drama scripts will be developed for Post Test Clubs and psychosocial support groups to incorporate ART messages in their music dance and drama presentations while clients will be trained on how to give testimonies on the importance of ART. The UPHOLD supported CSO district net works and local governments are expected to create linkages with outlets for ART including those established by major treatment centers such as the Joint Clinical Research Center (JCRC), Mildmay Center, Ministry of Health and faith-based healthcare facilities under the Inter-Religious Council of Uganda (IRCU) project. It is envisaged that the supported groups, various drama and radio program avenues will provide information on ART access points while also encouraging ART beneficiaries to adhere to the treatment.
This activity relates to Abstinence/Being Faithful (8456), Condoms and Other Prevention (8452), Orphans and Vulnerable Children (8453), Strategic Information (8455) and Palliative Care: Basic Health care and Support (8454).
Achievements to date: 69 individuals trained in laboratory-related infrastructure activities thus able to make 47 syphilis tests, 2,237 disease monitoring tests, 27,841 HIV tests and 651 TB tests.
In order to provide good quality basic health care services, healthcare workers need a well functioning laboratory to help in the diagnosis of opportunistic infections. Therefore, strengthening laboratory infrastructure and capacity is a key component of palliative care. Each of the 11 TASO centers has a laboratory that is able to carry out the minimum set of tests required to support an HIV/AIDS clinic. The tests include malaria testing, HIV testing.
TASO laboratories at the 11 centers will continue to be strengthened to support the delivery of basic healthcare and prophylaxis for opportunistic infections and ARV.
TASO proposes to strengthen and support laboratory services including procurement of laboratory reagents, and laboratory equipments necessary for the proper functioning of the laboratory. The cost for this activity will supplement the procurement of laboratory reagents in addition to what is provided by the National Medical Stores (NMS) with CDC's support .This will mainly be for reagents for tests including Malaria blood slides, syphilis testing, urinalysis and basic chemistry, excluding HIV testing and ART screening - CD 4 counts. Funds will also support laboratory human resource and training of the staff.
This activity also relates to Abstinence/ Being Faithful (8775), Condoms and Other Prevention (8467), PMTCT (8466), Palliative Care: Basic health Care and Support (8468), Counseling and Testing (8470) , Treatment Services: ART (8472), Treatment: ARV: Drugs (8471), Strategic Information (8474) and Other Policy Analysis and System Strengthening (8475).
Planned activities for year 2 will include continuing to build on the laboratory work currently being done by one of NUMAT partners, AMREF, and also supported by CDC. The project will strengthen the laboratory capacity at the lower level of the health systems, particularly HC III, by renovating infrastructure, training personnel and providing appropriate equipment to enable units to undertake appropriate laboratory tests for the diagnosis and treatment of HIV, TB and malaria. Previously trained HC III laboratory staff will receive refresher training in HIV rapid tests, sputum smears, total and differential white blood cell counting, hemoglobin testing and malaria smears. Clinical officers will receive in-service training in best practices in utilization of laboratory services. The project will increase the number of functional labs based on rapid assessments, through site renovations, equipment procurement and staff training. Capacity at referral labs will be increased through staff training and incentives, supplies and equipment. The project will support and strengthen systems to transport samples from lower level facilities to the referral labs to conduct higher level tests such as CD4 count, LFT, RFT and PCR. NUMAT will strengthen the laboratory quality assurance efforts already underway in the three districts in which AIM worked and expand these to include all project districts. The project will also work with district health officials to enhance their ability to conduct supervision activities.
Specific activities to be undertaken include:
Train all HC III in HIV rapid testing for HIV so they can support home-based HCT and PMTCT outreach linked to HC IIIs.
Develop HC III-focused quality assurance systems in support of broader district systems which AMREF is developing under CDC support.
Support the MOH's Human Resource Development strategy by sponsoring at least 30 currently unqualified staff to take the laboratory assistant's course.
Support laboratory staff to conduct outreach and provide services during national TB, HIV, child health, and malaria health days.
Train community health workers in referral for laboratory testing by creation of simple messages.
Support and strengthen systems to transport samples to referral labs to conduct tests like CD4 count, liver function tests, renal function tests and PCR.
Procure CD4 count machines for referral hospitals so they can provide care in accordance with national guidelines.
Pilot programs for integrated approaches for the diagnosis of HIV, TB and malaria.
Document and disseminate innovative approaches to integrating HIV, TB and malaria diagnosis.
This activity also relates to activities in Counseling and Testing (8433), Treatment: ART Services (8845), PMTCT (8434), Palliative Care: Basic Health Care and Support (8435) Palliative Care:TB/HIV (8431), Condoms and Other Prevention (8432), Other/Policy Analysis and Systems Strengthening (8838) as well as Abstinence and Being Faithful (8437).
Achievements to date: 7 local organizations have been provided with technical assistance for strategic information. 344 individuals have been trained in strategic information.
During this funding period UPHOLD will continue supporting activities aimed at promoting evidence-based planning and decision-making at district and lower levels. This will be achieved through regular measurement of program performance and progress in the 28 districts where UPHOLD operates as well as the provision of regular and timely feedback to UPHOLD supported local governments, non-governmental organizations and civil society organizations in 28 districts. This activity will be mainly conducted through the annual Lot Quality Assurance Sampling (LQAS) survey. This survey which is conducted in all the UPHOLD supported districts on an annual basis tracks coverage and utilization of key indicators related to program performance. Questionnaires for this survey will be updated with full participation of stakeholders (including line ministries, local government authorities, civil society organizations as well as development partners) who work in the target districts. Results will be used to inform district level work planning in order to identify intervention areas and sub-counties on which to focus in the future. It is planned that LQAS will also be used to track indicators under the President's Malaria Initiative that UPHOLD and other partners contribute to in the 28 districts where UPHOLD operates (currently 34 out of the 76 districts in the country including the Northern Uganda Project area).
The AIDS Information Centre (AIC) and The AIDS Support Organization (TASO) will continue to receive technical support through UPHOLD in order to improve their monitoring and evaluation capacity as well as their overall organization development. As sustainability of activities is one of the key issues that UPHOLD will have to address with its partners going forward, capacity building will also be continued for approximately 35 CSOs in order to further strengthen core areas such as monitoring, evaluation and reporting capacity; financial and programmatic reporting; budgeting and grant proposal writing. It is anticipated that such support will increase the chances of these organizations to attract funds from other developmental partners even beyond the life of UPHOLD. Support to the public health facilities and the districts in general will mainly focus on Health Management Information Systems(HMIS) strengthening as well as improving performance of District Planning Units (DPUs) in all the UPHOLD supported 28 districts. Training and support supervision activities will be an important part of this activity and key areas in data quality assurance will be covered. A total of 500 persons (from both local government and civil society organizations) will be trained in these various capacity building initiatives.
This activity also relates to Abstinence/ Being Faithful (8456), Condoms and Other Prevention (8452), Orphans and Vulnerable Children (84530, Laboratory Infrastructure (8451) and Palliative Care: Basic Health care and Support (8454).
TASO undertakes several activities aimed at adequately capturing up-to-date information that is relevant to the program needs. Emphasis will be placed on ensuring that TASO staff and staff of Mini-TASO and CBOs appreciate and utilize data in routine program management. This is in follow-up to the realization by TASO that some healthcare providers were not yet keen on maintaining and collecting strategic information about their programs, and also that several of those who collected various data were unable to translate such data into vital information that can inform decision-making and programming.
The target group for this intervention will be the heath care providers including certain cadres of TASO staff, staff of Mini-TASO Centres and partner CBOs. The Mini TASOs & CBOs to be targeted under this activity include Kaberamaido, Kumi, Pallisa, Virika, Kabale and Kasese. About 300 people from 15 organizations will be reached through this intervention. The activity will involve training in strategic information issues ranging from data collection (filling data forms), data entry, data cleaning, data analysis, data utilization and report writing. The training will also aim at developing the practice of evidence-informed/evidence-based decision-making among health care providers. This will be a follow-up of the lessons learned by TASO that often health care providers fail to collect, manage and utilize important data generated by their programs.
The targeted populations will be reached through special workshops and seminars focused to achieving the above aims. For TASO Centres, workshops will be conducted at the respective service centers in addition to national events that will be organized. Staff of the Mini-TASO and CBO sites will be reached through workshops in their respective places of work. Workshops will also be held regionally to facilitate sharing of experiences among the Mini-TASO/CBO and TASO Centers.
In addition to the above, TASO will continue upgrading and improving the various strategic information systems at all Service Centres and Headquarters. Improvement/upgrading will involve reviewing data collection tools, procedures, software, analysis and reporting. This will aim at orienting systems to support the goal of promoting evidence-informed/evidence-based decision-making at various programme levels. TASO will procure equipment to facilitate the less-resourced information units in the newer Centers of Rukungiri, Masindi, Soroti and Gulu.
TASO will also aim at creating appreciation of the role of strategic information to broader program issues like monitoring and evaluation, program management and leadership, accountability and reporting, advocacy and resource mobilization.
This activity also relates to Abstinence/ Being Faithful (8775), Condoms and Other Prevention (8467), PMTCT (8466), Palliative Care: Basic Health Care and Support (8468), Counseling and Testing (8470) , Treatment: ARV Services (8472), Treatment: ARV Drugs (8471), Laboratory Infrastructure (8473) and Other/ Policy Analysis and System Strengthening (8475).
The planned key achievements in year 1 under this programme area include providing technical assistance for strategic information activities to 10 organisations and training 25 people in strategic information.
Year 2 activities will build on year 1 achievements and will include; Strengthening existing data collection mechanisms in place within the health system in all districts. The project will train district HMIS Focal Persons (FP) to manage data collection from the lower level health units and facilitate analysis, dissemination and reporting of data. Record assistants at health sub-districts will be sensitized, equipped with skills and facilitated to extract data from service registers and enter into summary forms. Where necessary, the project will support procurement of equipment to facilitate collection analysis and storage of data at the district level. The HMIS Focal Persons and the record assistants will be supported in data collection. Districts will be supported to routinely utilize data for their planning purposes and supporting service delivery. In addition districts will continue to be supported annually to conduct LQAS exercises to monitor progress on critical HIV/AIDS, TB and malaria indicators.
District planning units will also be trained and supported to manage data generated from the project and other partners. The project will work with the Community Services Department (CSD) to strengthen and roll out existing community services data collection mechanisms.
This activity also relates to Abstinence/Being Faithful (8775), Condoms and Other Prevention (8467), PMTCT (8466), Palliative Care: Basic Health Care and Support (8468), Counseling and Testing (8470) , Treatment : ARV Services (8472), Treatment: ARV Drugs (8471), Laboratory Infrastructure (8473) and Strategic Information (8474).
The project will work with UAC to operationalize the National HIV/AIDS Coordination Guidelines in the program districts and adapt them to reflect the reality of IDP situations. In districts where DACs are well organized and operational (Lira, Apac and Kitgum) they will be strengthened through training and logistical support. In districts where these structures are weak or nonexistent (Pader and Gulu) the project will support existing Sector Working Groups structures, like the DMMC, to ensure improved coordination of HIV/AIDS/TB activities. The project will advocate and work closely with the local government leadership to ensure high profile officers are named to the District Focal Point positions. Logistical support, incentives, facilitation and training in multi-sectoral coordination of HIV/AIDS will be provided to focal point persons to enable them perform their roles more effectively. Technical and logistical support will also be provided to the sub-county coordination structures (Sub-country AIDS Committee and Task Force - SACs and SATs). The project will also support camp management structures to plan, coordinate and monitor implementation of HIV/AIDS activities and encourage linkages with SACs. The project will support coordination, networking and referrals among service providers in sub-counties and IDP camps. Camp structures will be strengthened to ensure coordination is strengthened at the lowest level of IDP camps.
At the district level, the project will work within the National Committee on AIDS in Emergency Settings (NACAES) recommended framework to support all district coordination structures to more effectively perform planning and coordination of HIV/AIDS/TB activities. These structures include the DDMCs, the DACs and DATs. The project will work with other existing coordination mechanisms including UNOCHA and other UN bodies operational in the region to ensure approaches and strategies are harmonized and linkages to wrap-around services are re-enforced.
In view of the acute human resource constraints facing the conflict affected districts of the North, one specific area that the project will put focus on is to work with other stakeholders to address innovatively the critical human resource gaps in the region. NUMAT will collaborate with UNICEF in the implementation of the minimum package of Health Facilities support and with others to design and implement appropriate incentive packages that will be linked to a broad human resource support strategy in conflict and post conflict districts.
In addition to strengthening the official coordinating bodies, the project will work with UNASO to strengthen networking and AIDS Service Organization (ASO) capacity in project districts. UNASO members in each of the districts will be supported to select representatives to the district coordination and planning bodies. They will also be provided with support to hold routine meetings of partner organizations to share lessons learned and best practices. We will also partner with NAFOPHANU to strengthen and/or establish district PHA networks and to mobilize and support PHA groups in the IDP camps. In the IDP camps, through PTC and PSSs, newly identified PHAs will be encouraged to form new or join existing PHA groups in the camps. The district PHA networks will also be supported to facilitate processes of identifying and selecting their representatives to the district HIV/AIDS coordination and planning structures, taking into consideration not only HIV-status but also gender and age.
Working with the DACs, DDMCs, other district structures and other stakeholders in the districts, the project will support processes in the districts to harmonize the different plans currently in place and identify priority areas for supporting. The jointly identified priorities that are in line with the project's objectives will form part of the project's initial work plan.
This activity also relates to activities in Counseling and Testing (8433), Treatment: ART Services (8845), PMTCT (8434), Palliative Care: Basic Health Care and Support (8435) Palliative Care: TB/HIV (8431), Condoms and Other Prevention (8432), Strategic Information (8436), as well as Abstinence and Being Faithful (8437).
Due to the fact that a supportive policy environment is very important for the implementation of activities, UPHOLD will complement the efforts of the Ministry of Health (MoH), Ministry of Education (MoE) and the Ministry of Gender, Labor and Social Development (MoGLSD) towards the dissemination of policies that are relevant to the activities that the program supports. In particular, in the 28 districts where HIV/AIDS related activities will be supported during FY07, UPHOLD will support the rolling-out of the revised PMTCT and RCT policies so that they are accessible and well understood at the frontline level of implementation. UPHOLD will also build on past efforts by AIM and Uganda AIDS Control Program (UACP) to strengthen district planning (fresh support for the new districts) through providing continued support to the District AIDS Committees. The support will facilitate streamlining district capacity to manage HIV/AIDS structural plan development, coordinating of activities and monitoring progress.
Additional support will be provided for the completion and dissemination of policies and/or guidelines on integrated TB/HIV management, the management of opportunistic infections, the scaling-up of use of the utilization of co-trimoxazole prophylaxis among PHLAS as well as the provision of isoniazid prophylaxis in PHLAs at high risk of acquiring tuberculosis.
UPHOLD will also support the printing and distribution of policies and implementation guidelines and the re-training and orientation of health workers to improve service delivery in HIV/AIDS management. These activities will target UPHOLD supported public and private health facilities providing HCT/PMTCT/Palliative care services. It is anticipated that in ensuring that the policies and guidelines are easily accessible, user friendly and implemented, legislative issues such as increasing gender equity in HIV/AIDS programs, reducing the incidence of gender based violence, reducing stigma and discrimination as well as influencing male norms and practices will also be addressed in order to further improve HIV/AIDS service delivery.
It is planned that a total of 1,000 persons (including health workers and CSO personnel) will be trained on the new/revised policies and guidelines.