Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4842
Country/Region: Uganda
Year: 2007
Main Partner: Joint Clinical Research Center
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $17,504,865

Funding for Care: Adult Care and Support (HBHC): $340,000

This activity also relates to Palliative Care:TB/HIV (8445), Treatment: ARV Drugs (8443), Treatment :ARV Services (8444), and Laboratory Infrastructure (8441).

The Joint Clinical Research Centre (JCRC) is an indigenous and the first autonomous organization to provide ART in Uganda. Established in 1992 to undertake AIDS vaccine research and an early Drug Access Initiative Partner, JCRC began providing ART on a large scale to clients at their clinic in the capital city Kampala in 1998. In 2002 JCRC began transferring expertise to other health facilities in the Ministry of Health network. By mid 2003, JCRC was the largest provider of ART on the African continent, with over 10,000 people on treatment. A cooperative agreement with USAID in 2003 launched an extensive expansion of ART across the country and a major increase in the number of PHAs able to access care and treatment. JCRC has expanded from 4 to 40 ART sites, currently serving over 17,000 current clients on ARVs, as at the end of July 2006, including over 8,900 orphans and vulnerable children, orphans' care takers, pregnant women and health care workers, receiving treatment as part of a fully subsidized program,.

With funding in FY2007, JCRC will expand services to 7 additional sites bringing the total sites to 50 ART sites, and reaching a minimum of 30,000 people, including 20,180 orphans and children, orphans' care takers, pregnant women, health care workers and other vulnerable groups receiving fully subsidized treatment. Strong collaborations exist with the Ministry of Health, Elizabeth Glazer Pediatric AIDS Foundation (EGPAF), Walter Reed Project, Makerere University John Hopkins (MU-JHU), UPDF, UWESO, World Vision, and faith based organizations. These linkages will connect pregnant women and children to ART centers for early diagnosis, palliative care and treatment where required.

With FY 07 funding, JCRC will provide HIV related palliative care services to 65,000 clients. Services provided to all clients reporting for HIV/AIDS clinical care at any of the 50 JCRC supported sites will include: HIV testing, diagnosis of opportunistic infections including TB (see Palliative CARE TB section), immunological tests including CD4 and PCR for pediatric diagnosis. This capability already exists at JCRC and will be extended to regional centers of excellence, which are Mbale in the East, Fort Portal, West, Kabale, South West, Gulu, North, Mbarara (has been strengthened to achieve capability in Flow Cytometry, CD4 and viral load, but will run autonomously) and Kakira, Central. For those HIV+ patients who are not at a stage to require ART, will be followed up closely at JCRC satellite centers and at lower level health centers where other partners have the capacity to manage HIV care. TREAT will provide care and support for patients undergoing testing and found to be HIV+ but not at the stage for ART through regular clinical assessment within the health care system (facility and outreach). In addition, this will include diagnosis and treatment for OIs, prophylactic treatment of OIs, family planning, pain management, coordination and referral to other care and support services both within and outside the health network. Most of the patients will require cotrimoxazole prophylaxis as preventive care, in accordance with the Ministry of Health guidelines. JCRC will work with the logistics and procurement systems at sites (MOH and NGO) to ensure full supply and distribution. JCRC will ensure adequate availability of preventive and palliative care, such as provision of LLITNs, safe water, family planning, psychosocial support and counseling, nutritional support, etc. through the existing facility, PHA networks or other groups in the community best able to deliver those services. Patient and community support groups will be strengthened or established at each facility adherence to care and be a conduit to provide elements of preventive and palliative care directly to clients. These will be closely linked to the adherence officers at sites. Pain management and provision of morphine will be delivered through linkages with Hospice Uganda which has an expanded program to train and deliver palliative care/pain management nationally. TREAT facilities will also have capacity to undertake home care and pain management through direct or networked provision.

Finally, the 50 JCRC direct and satellite sites will be involved in HIV prevention as part of comprehensive HIV/AIDS care and prevention in positives. JCRC will take on board established packages of preventive and palliative services either through the health facility or other organizations working with the health facilities.

Funding for Care: TB/HIV (HVTB): $225,000

This activity also relates to Palliative Care: Basic Health Care and Support (8442), Treatment: ARV Drugs (8443), Treatment: ARV Services (8444), and Laboratory Infrastructire (8441). The Joint Clinical Research Centre (JCRC) is an indigenous and the first autonomous organization to provide ART in Uganda. Established in 1992 to undertake AIDS vaccine research and an early Drug Access Initiative Partner, JCRC began providing ART on a large scale to clients at their clinic in the capital city Kampala in 1998. In 2002 JCRC began transferring expertise to other health facilities in the Ministry of Health network. By mid 2003, JCRC was the largest provider of ART on the African continent, with over 10,000 people on treatment. A cooperative agreement with USAID in 2003 launched an extensive expansion of ART across the country and a major increase in the number of PHAs able to access care and treatment. JCRC has expanded from 4 to 40 ART sites, currently serving 17,289 on ARVs, as at the end of July 2006, including over 8,900 orphans and vulnerable children, orphans' care takers, pregnant women and health care workers, receiving treatment as part of a fully subsidized program,.

With funding in FY2007, JCRC will expand services to 7 additional sites bringing the total sites to 50 ART sites, and reaching a minimum of 30,000 people, including 20,247 orphans and children, orphans' care takers, pregnant women, health care workers and other vulnerable groups receiving fully subsidized treatment. Strong collaborations exist with the Ministry of Health, Elizabeth Glazer Pediatric AIDS Foundation (EGPAF), Walter Reed Project, Makerere University John Hopkins (MU-JHU), UPDF, UWESO, World Vision, and faith based organizations. These linkages will connect pregnant women and children to ART centers for early diagnosis, palliative care and treatment where required.

The TREAT program will deliver a comprehensive package of care for TB through collaboration with the national TB program. It is expected that 4,500 (15% of minimum patients to be reached, as stated above) HIV infected clients will receive treatment for TB through this program. The national TB guidelines will be followed, and drugs supply will be collaboration between TREAT and TB national control program set up with MOH. The TB liaison makes treatment of HIV care and treatment very closely linked especially as there are critical issues related to disease progression, drug toxicity and interactions. Therefore it is critical that clinical supervision and service logistics are linked. In collaboration with national TB program, JCRC will support a reliable system to monitor TB related data to inform reciprocal responses and improvement of ART patient management including monitoring. The majority of the TREAT sites are Ministry of Health regional or district hospitals, all of which have a TB program and most are implementing CB-DOTS. Overt connections between HIV care and ART clinics and TB clinics will be sought. In addition, MOH facilities are beginning to roll out routine counseling and testing on hospital wards, which will uncover TB clients who are co-infected. Likewise HIV clients will be evaluated for TB and supported for TB treatment as part of the package of care. In addition, the regional centres of excellence will continue to provide capacity for TB research and HIV/AIDS research, especially in Mbarara and Fort Portal.

JCRC's training program incorporates TB diagnosis and treatment, as do other training centers that support TREAT clinics (e.g. Mildmay, TASO, IDI). JCRC has developed monitoring tools for centers and strong logistics to ensure reliable drugs and commodities supplies, stocks management, data collection and monitoring and day-to-day communication. TREAT continues to establish and strengthen patient support groups and community based organizations to work with the adherence program to ensure the success of the program.

Funding for Treatment: ARV Drugs (HTXD): $10,168,754

This activity also realted toPalliative Care: Basic Health Care and Support (8442), Palliative Care: TB/HIV (8445), ARV Treatment Services (8444), and Laboratory Infrastructure (8441).

(Joint Clinical Research Center is an indigenous Uganda NGO established in 1992 to undertake AIDS vaccine research and provide treatment to HIV positive individuals. JCRC began providing ART on a large scale to clients at their clinic in the capital city Kampala in 1998. By mid 2003, JCRC was the largest provider of ART on the African continent, with over 10,000 people on treatment, and an internationally respected training and research institution. Many of the PEPFAR countries have sent delegations to Uganda to learn about how JCRC was able to rapidly expand treatment. In 2002 JCRC began transferring expertise to other health facilities in the Ministry of Health network. A cooperative agreement with USAID in 2003 envisioned a much more extensive expansion to introduce and support ART across the country. The main approach to scaling up HIV care and Treatment services has been to assess needs and provide support for minor infrastructure improvements, communications systems, logistics and supply systems including ARV drugs, supplemental staffing and human resources, training and quality assurance. Each site enters into an agreement with JCRC outlining the areas of support provided and ensuring that the sites are able to sustain and manage the additional services. As part of the national program, sites are accredited and are then eligible for receipt of Global Fund drugs as well.

Under the TREAT program, since October 2003, JCRC has expanded ART from four to 40 sites- the majority are Ministry of Health centers and 30% are faith based, military or private sites. Seven additional sites will be opened with FY2007 funds for a total of 50. As at the end of July 2006, over 17, 289 people were currently receiving ART services through the network of health facilities, including over 8,900 orphans, vulnerable children, pregnant women, orphan caretakers, health workers as part of a fully subsidized program. The additional estimated 8389 are currently receiving drugs through the Global Fund, however there have been shortages in some drugs requiring JCRC to provide buffer stock. By March 2007, 12550 will be reached (with FY2006 funds) with fully subsidized treatment. While it was projected that clients served at sites where JCRC is working would treat approximately 25,450 people by March 2007, experience over the past year shows that this may have been too ambitious given erratic drug supply and a wider network of service providers requiring GF drugs and wealth of providers.

With FY 2007 funding, the total number of people reached with these funds as current clients will be 36,917, with 18,917 vulnerable groups receiving fully subsidized treatment from JCRC and 18,000 receiving ARV services from JCRC and drugs from Global Fund during this funding period. With an earmark of $250,000 within this budget JCRC will provide ARV drugs to 416 Uganda People's Defense Force members, and with FY 07 additional funding (US$ 226,213), JCRC will provide ARV drugs to Walter Reed clients (DOD) working in Kayunga District. Additionally training and infrastructure support will be provided to UPDF, and training support to Kayunga. With current drug costs declining far more people will be treated with the available funds. At the current estimate, adult drugs costs for first line are approximately USD $30-40 per month (excluding supply chain costs) and second line at approximately $123/month. Average costs for children first line syrups are $60/month with adolescents on first line pills at $54. Second line drugs for children average $82/month. Expectations with new approvals of generic fixed dose combinations may lower costs further to allow many more clients to potentially be treated.

In FY 07, a total of 50 sites (7 additional) will be supported. A major new thrust in 2006 and continuing in 2007 will be the operationalization of the Ministry of Health's national early infant diagnosis program. The program is in process of rolling out and agreements have been outlined whereby the Ministry manages a network of courier routes through Uganda Posta to transfer samples from lower level center to the JCRC Regional Centers of Excellence which have capacity to process PCR/DNA and all HIV related test. The system is still in infancy, but with FY2007 funding up to 9000 infants will be tested and either directly provided or referred for HIV care services and treatment at a lower level site. The current network established by EGPAF with the Ministry of Health will continue to support HIV positive mothers and infants for care and treatment at lower level centers, with referrals for HIV disease monitoring to the JCRC Regional Centers of Excellene. Leveraging the business sector and health insurance, GFATM and individual capacity to

contribute to the costs of treatment will allow for increased numbers of people served, as will significant reductions in drug costs as a result of more FDA approved generic ARV drugs become available and licensed by the Uganda National Drug Authority (NDA). With technical support from Supply Chain Management System (SCMS), JCRC will continue to improve the logistics system and implement state of the art software for logistics and pharmaceutical management information system at the TREAT sites. In 2007 the computerized logistics system will be rolled out to the Regional Centres of Excellence (RCE). The TREAT program will train pharmacists, dispensers and providers in HIV and AIDS related commodities. Infrastructure will be further developed to ensure commodity security, direct procurement and management of pharmaceuticals for all sites, distribution systems and schedules for delivery. JCRC will continue to work with partnership for Supply Chain Management System to ensure a robust logistics and supply system.

Currently JCRC procures drugs directly through suppliers and Medical Access. JCRC also serves as a supplier for other NGOs and the GOU as an alternative supply line.

OGAC Review: JCRC fees for service - we know there are certain defined vulnerable groups, but please explain the distinction. Apparently, <1% of patients now pay for drugs, but how about lab tests? JCRC provides ART services and drugs free of charge to vulnerable groups (which include all children, women and their spouses) who say they cannot pay (self declared). In FY04 JCRC treated 4095 children with ARV drugs and services; in FY05 JCRC treated 9268 children, women and their spouses with ARV drugs and services; 12550 and 18917 are targeted with FY06 and Fy07 funds respectively. Beginning mid 2006 and in FY07 lab services for these clients are also free of charge. Again, we reiterate that JCRC also supports clinical care services for clients in the current 43 sites (50 planned with FY07 funds) who receive drugs from Global Fund as an integrated approach under the Ministry of Health system, and these are captured as direct clients per OGAC guidance.

Labs. Additionally JCRC will support with PEPFAR funds lab services for PCR DNA for all pediatric samples (free) in partnership with MOH through the Regional Centers. Funds are not sufficient to provide all required laboratory services at all 50 sites, however since JCRC has capacity for serving the broader community with laboratory services, they do provide this service for a minimum fee.

Funding for Treatment: Adult Treatment (HTXS): $5,371,111

This activity also relates to activities in Treatment: ARV Drug s (8443), Laboratory Services (8441), Palliative Care: Basic Health Care and Support (8442) and Palliative Care: TB/HIV (8445). There are also linkages with Quality Assurance Program, SCMS, Family HIV/AIDS care and treatment program, DOD, Walter Reed, AFFORD ,IRCU, JHU-HCP; IHAA networks. The program will work with LMS and CPHL for lab quality management and many others. Joint Clinical Research Center is an indigenous Uganda NGO begun in 1992 for AIDS vaccine research and provide treatment to HIV positive individuals. By mid 2003, JCRC was the largest provider of ART on the African continent, with over 10,000 people on treatment, and an internationally respected training and research institution. . JCRC's approach to national scale up is to assess unique site needs, provide support for minor infrastructure improvements, communications systems, logistics and supply systems including ARV drugs,supplemental staffing and human resources, training and quality assurance. Sites enter into an agreement with JCRC outlining the areas of support provided and ensuring that the sites are able to sustain and manage the additional services. All sites are also receiving drugs from Global Fund. JCRC has expanded ART from four to 40 sites; the majority are Ministry of Health centers and 30% are faith based, military or private sites. Seven additional sites will be opened with FY2007 funds for a total of 50. As at the end of July 2006, over 17,289 people were currently receiving ART services through the network of health facilities, including over 8,900 orphans, vulnerable children, pregnant women, orphan caretakers, health workers as part of a fully subsidized program. The additional estimated 8389 are currently receiving drugs through the Global Fund, however there have been shortages in some drugs requiring JCRC to provide buffer stock. By March 2007, 12550 will be reached (with FY2006 funds) with fully subsidized treatment. While it was projected that clients at the JCRC site would treat approximately 25,450 people by March 2007, experience over the past year shows that this may have been too ambitious given erratic drug supply and a wider network of service providers requiring GF drugs and wealth of providers. With FY 2007 funding, the total number of people reached with these funds as current clients will be 36,917, with 18,917 vulnerable groups receiving fully subsidized treatment from JCRC and 18,000 receiving ARV services from JCRC and drugs from Global Fund during this funding period. JCRC will provide ARV drugs to 416 Uganda People's Defense Force members ($250,000), will provide ARV drugs to Walter Reed clients (DOD) working in Kayunga District ($226,213). Additionally training and infrastructure support will be provided as well. New sites will be selected in consultation with the MOH and other HIV/AIDS partners. Major interventions include development of infrastructure, logistics systems, ARV and other drugs, human resources and training, laboratory equipment and services, communications and data management systems, referral systems for palliative care and support, basic preventive care and robust adherence systems. Existing sites will continue to be supported, with a strong focus on quality through an adherence program. In addition, the quality focus entails ensuring laboratory monitoring for clients within and beyond the TREAT network. Partnerships will be strengthened with other organizations including CDC, AMREF to address the challenges of inadequate laboratory infrastructure for the delivery of quality ART. JCRC will consolidate the established 6 Regional Centers of Excellence (RCE) begun in 2005 to provide specialist fully functional laboratory services as part of the JCRC organizational outreach. To ensure quality, the administrative maintenance of the Regional Center's of Excellence will be run entirely by JCRC under TREAT, with capacity building of Ministry of Health staff over time. The RCEs will serve as referral labs for each region. The JCRC RCEs will provide capacity for the MOH initiative for infant testing to identify children in need of treatment, care and support at an early stage.The mainstay of the program in 2007 will be continued focus on adherence. The adherence strategy encompasses central coordination at JCRC, regional adherence officers, down to satellite adherence assistants and volunteers and including patient support groups and community organizations. Adherence interventions include measuring of adherence levels through self report, pharmacy records and clinic registers at TREAT facilities. Clients who will be found least adhering to ART will be followed up through phone calls and home visits. Community liaison volunteers will be identified, recruited and trained to follow up clients at home and adherence support clubs will be strengthened. Novel methods will be employed including use of mobile phones, messaging, buddy patients, clinic records for tracking defaulters. Adherence training for all staff and patient supports will include use of developed materials. Special focus on pediatric AIDS will continue whereby 35 PMTCT sites in the EGPAF network will link HIV+ pregnant mothers, and families to JCRC and other clinics. At regional centers, PCR for viral load and DNA assays will enable early diagnosis and

treatment of infants. JCRC will build on the work accomplished with JHU-HCP, and MoH during FY 06which involved implementation of a national campaign to increase awareness and acceptance of ART through local radio programming supported by branded billboard, poster, and materials. The program also developed adherence manuals and supports for clients and providers and implemented a training program with support from JHU. The program has reconstituted a national ART Communication Working Group to guide a national communication effort through which JCRC is the lead organization in ART communication in Uganda. HCP will provide technical assistance to group to design and implement an expanded national communication effort involving all ART partners in Uganda. Communication in FY07 will focus on adherence, stigma reduction, and prevention among positives and activities will reach communities living within 5 kilometers of sites providing ART services, PLHAs, and ART clients.Training is a major focus for JCRC and in FY07, health workers will continue to be trained in ART provision in all the 48 ART sites, with refresher courses for the operational sites through collaboration with Academic alliance, IDI, TASO, Mildmay and University of Wisconsin. Training materials curricula will be developed for laboratory technicians and Paediatric counselors. Training will also target community liaison volunteers, PHAs and patient support groups. The LMIS and the pharmaceutical Inventory Logistics System (PILS) will be strengthened at sites to back up the paper-based system. Real-time information about drugs dispensed and number of patients receiving ART will be operationalized. JCRC will work with the Supply Chain Management System (SCMS) to strengthen the logistics system. The RCE's will strenghten supply and management of laboratory reagents and other supplies. Collaboration with SCMS for refresher logistics training for all TREAT site staff is to be undertaken including supervisory visits to ART centers. ART monitoring tools will be evaluated and improved in all TREAT sites with a focus on improving the computerized patient database and using program data to inform management.

Funding for Laboratory Infrastructure (HLAB): $1,400,000

This program is closely related to Treatment: ART Services (8444), Treatment:ARV Drugs (8443) , Palliative Care: Basic Health Care and Support (8442), Palliative Care:TB/HIV (8445) . Joint Clinical Research Center is an indigenous Uganda NGO established in 1992 to undertake AIDS vaccine research and provide treatment to HIV positive individuals. JCRC began providing ART on a large scale to clients at their clinic in the capital city Kampala in 1998. JCRC has expanded ART from four to 40 sites- the majority are Ministry of Health centers and 30% are faith based, military or private sites. Seven additional sites will be opened with FY2007 funds for a total of 50. As at the end of July 2006, over 17, 289 people were currently receiving ART services through the network of health facilities, including over 8,900 orphans, vulnerable children, pregnant women, orphan caretakers, health workers as part of a fully subsidized program. The additional estimated 8389 are currently receiving drugs through the Global Fund, however there have been shortages in some drugs requiring JCRC to provide buffer stock. By March 2007, 12550 will be reached (with FY2006 funds) with fully subsidized treatment. While it was projected that clients served at sites where JCRC is working would treat approximately 25,450 people by March 2007, experience over the past year shows that this may have been too ambitious given erratic drug supply and a wider network of service providers requiring GF drugs and wealth of providers.

With FY 2007 funding, the total number of people reached with these funds as current clients will be 36,917, with 18,917 vulnerable groups receiving fully subsidized treatment from JCRC and 18,000 receiving ARV services from JCRC and drugs from Global Fund during this funding period. Laboratory diagnostic and monitoring tests are prohibitively expensive for most patients and yet quality lab tests are absolutely essential for a quality program. Lab tests (PCT/CD4 and CBC as well as essential chemistries and OI diagnostics) will be subsidized for all pediatric clients. Those able to pay for tests will contribute to the service, while other poor and vulnerable groups will continue to be subsidized. In collaboration with USAID and other partners more efforts will be made to further reduce the costs of laboratory diagnosis and monitoring test. An adult patient needs 2 CD4 tests per year, 2 CBC tests per, 3 essential chemistries Per year (Liver, kidney, renal tests). The rapidly evolving demand for HIV treatment with antiretroviral drugs in Uganda poses a challenge with regard to HIV testing, monitoring of patients and drug resistance. With expansion of the ‘TREAT" program, the demand for laboratory strengthening has increased greatly in Uganda. However, presently the laboratory infrastructure for anti-retroviral support and quality assurance remain weak in Uganda due to lack of equipment and trained manpower. The JCRC response during FY07 will be to consolidate and strengthen the 6 Regional Centers of Excellence (RCEs) to provide regional oratory referral services. This will involve addressing human resource issues to be able to provide a quality program as the volume of lab tests is likely to increase with the MOH strategy for the country wide early diagnosis of HIV among infants and young children. The RCEs will perform sophisticated tests like CD4 cell count, viral load and OI diagnosis.

With FY07 funding JCRC RCEs will provide capacity for the MOH strategy for early diagnosis of HIV among infants and young children. The RCEs provide quality assurance for the TREAT laboratories, capacity building for the public health laboratory network and a fall back to the public health regional hospitals, the target for infants to be tested is estimated at up to 9,000. Of these it is assumed that 2,250 are HIV positive, they will need CD4 and CBC tests. In addition, it is estimated that around 450, of the kids will need treatment and lab services. Needed labs will be provided to all persons receiving fully subsidized services; global fund and other clients on a targeted bases. At least 4,000 children will need on going support, this will include 3 chemistry tests per child per year, OI tests including TB and malaria tests and other OI tests, bacterial infections etc.

To build systems, JCRC will provide training support on request for the 50 TREAT centers and will establish referral of samples for more complicated tests from ordinary ART sites to the Regional Centers of Excellence. The RCEs provide support supervision and quality control of other labs in the region, to improve the reliability of the laboratory results. Resistance testing will only be available at JCRC Mengo. JCRC will continue to utilize technical assistance from MSH to offer management and leadership training for the laboratory staff. More training will include technical areas of diagnostics ranging from HIV testing, TB, Syphilis and OI diagnostics, HIV patient monitoring and quality assurance. The Regional Centres of Excellence will continue to provide capacity for TB and HIV/AIDS

related research for MOH and JCRC partners, such as Case Western Research University, Ohio. Mbarara University is also utilizing the laboratories for potential research for the medical school. PEPFAR partners such as MJAP in Mbarara will continue to utilize the JCRC labs.

JCRC will continue to work and collaborate with the MOH and AMREF in strengthening the national laboratory network. JCRC regional centers of excellence will provide capacity building for the MOH laboratory personnel; emergency and technical backstopping for the public health laboratory network and also provide a fall-back to the regional hospitals in cases of emergency reagent stock-outs.

OGAC Reviews: JCRC fees for service - please clarify how this works (for lab tests)

See question under ARV section on JCRC. It is worth a mention here however that our leveraging of private sector supports has enable more people in communities to access services including labs, supported in full by private sector companies, who are procuring lab services from JCRC through the regional centers in increasing numbers.

Subpartners Total: $17,279,574
Mbale Regional Referral Hospital: $761,900
Apac Hospital: $256,000
Ishaka Adventist Hospital: $187,500
Kagando Hospital: $187,500
Kisiizi Hospital: $218,000
Kitgum Government Hospital: $285,500
Ngora Freda Carr Hospital: $343,500
Rushere Community Health Center: $187,500
St. Paul's Health Center, Kasese: $187,500
Regional Referral Hospital, Kabale: $761,900
Kakira Sugar Plantation Hospital: $711,900
Regional Referral Hospital, Hoima: $238,500
Regional Referral Hospital, Lira: $598,500
Regional Referral Hospital, Jinja: $207,500
Regional Referral Hospital, Gulu: $987,287
District Hospital, Kabong: $155,500
District Hospital, Mubende: $208,000
Regional Referral Hospital, Mbarara: $1,231,900
Soroti Regional Referral Hospital: $187,500
Health Center, Mukujju IV: $156,000
Health Center, Kasana IV: $207,500
Iganga District Hospital: $187,500
Bombo Military Headquarters, Uganda: $238,500
Nyakibale Hospital: $290,500
District Hospital, Kitagata: $238,500
District Hospital, Kamuli: $187,500
Kayunga Hospital: $293,500
Buhinga Regional Hospital: $711,900
Joint Clinical Research Center: $2,031,213
Moyo District Hospital: $156,000
Kawolo Hospital: $187,500
Gombe Regional Hospital: $187,500
Ibanda Hospital: $187,500
Kisoro District Hospital: $156,000
Makerere University: $343,500
Katakwi Hospital: $256,000
Health Centre, Bukwa IV: $225,500
Nebbi District Hospital: $306,000
Pallisa District Hospital: $235,500
Kiboga District Hospital: $242,287
Kaberamaido Hospital: $256,000
Pader District Hospital: $256,000
Masindi Hospital: $287,500
Itojo Hospital: $258,611
Health Centre, Kitwe IV: $165,500
St. Francis Hospital, Nsambya: $195,713
Gulu Military Barracks: $186,000
Namugongo Health Centre: $186,000
Hope Clinic: $82,750
Uganda Peoples Defence Forces: $250,000
U.S. Military HIV Research Program: $226,213