Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 1257
Country/Region: Uganda
Year: 2008
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $8,040,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $200,000

The HHS/CDC Uganda Management and Staffing (M&S) budget for FY 2008 supports the USG goal for

appropriate staffing and level of effort in order to provide technical assistance, programmatic oversight, and

performance monitoring for all implementing partner activities. CDC GHAI funds support direct technical

assistance to in-country implementing partners for strengthening national surveillance and policy initiatives,

developing laboratories services, improving care and treatment programs, expanding counseling and testing

approaches, enhancing PMTCT activities and TB/HIV integration, and implementing public health


In FY08 the CDC staffing chart includes a planned position to work with the Ministry of Health's (MOH)

national prevention of mother-to-child HIV transmission (PMTCT) Coordinator, Protecting Families Against

AIDS a local NGO, and the Tororo District Hospital for the provision of technical assistance to review

PMTCT service delivery models and identify best practices to inform the national policy and the technical,

operational, and organizational components of PMTCT program implementation. This position is essential

to ensure continuation of the high quality technical assistance provided to-date for enhancing indigenous

partners' capacity for PMTCT service delivery and thereby contributing to the long-term sustainability of

PEPFAR activities.

Funding for Laboratory Infrastructure (HLAB): $981,732

In FY07 the CDC-Uganda lab continued to offer high quality HIV related services; these included serological

testing for HIV, HHV-8, HSV-2, and Hepatitis B; CD4+ and CD8+ cell counting, hematology, serum

chemistry and viral load testing. The lab also introduced PCR techniques to diagnose HIV from dried blood

spots collected from infants. Testing services were provided for CDC studies and for partners who had no

established lab capacity of their own. The CDC lab also provided technical assistance and training for lab

staff to PEPFAR implementing partners and to MOH facilities in order to enhance national lab services

capacity. During FY07, the CDC lab continued to assist in health service policy development and the

restructuring of CPHL to take on a central role in improving the standards of testing in health service

laboratories, including HIV testing services. In addition to expanding this initiative in FY08, the need for lab

management training will also be addressed as well as continuation of the roll-out training program for rapid

testing. In FY08 CDC laboratories will continue to support partners by providing services where they are not

available and will also continue to assist in building capacity in both partner laboratories as well as MOH

laboratories. Skills, such as PCR for the national HIV infant testing programs will be disseminated to other

laboratories with capacity so the program can be extended to cover a greater proportion of the population.

This will entail provision of technical training in the CDC laboratories, follow-up and support supervision to

ensure quality of testing and enrollment in external quality assurance programs. In order to integrate

services and technical assistance the lab works closely with the MOH Lab Technical Committee (LTC) and

with the health lab service sector. This includes the Ministry of Health, in developing a national lab health

service policy, the Ministry of Education and Sport to support lab technician training schools, the Central

Public Health Lab (CPHL) to develop its role in coordination of reference lab and lab support programs, the

National TB/Leprosy Lab (NTLP) to provide quality assurance programs and re-establishing an HIV

Reference Lab (HRL). The lab also works closely with the National Medical Stores for commodity

procurement. The CDC lab will continue to provide high-end diagnostic services required for eligibility

screening and monitoring of patients on ART, as well as developing, validating and monitoring new,

appropriate approaches to diagnostic testing. The lab will upgrade its procedures to obtain College of

American Pathologists (ACP) accreditation, thus ensuring that testing procedures and results meet

internationally acceptable standards.

Funding for Strategic Information (HVSI): $899,504

The CDC Informatics Unit provides technical assistance for the development and implementation of

strategic information systems to the country office and national prevention, care and treatment

implementing partners. These service providers, who are key recipients of PEPFAR funds, are given direct,

hands-on support by the informatics team to design strategic information systems tailored to meet the

specific needs of the programs and to build institutional capacity across the organization. The team actively

engages partner management and clinic staff at all levels to build consensus and develop applicably

standards for effective information system development. Strategic information program interventions range

from the design of patient care records, clinic management and logistics system to the integration of

monitoring and evaluation of national indicators between the MOH HMIS and the PEPFAR program.

CDC Uganda informatics Unit will continue to provide guidance to our partners and develop software

following proven computer software design techniques such as structure programming, industrial data base

data management standards will be used and taught. System development planning will be based on the

practical needs of the partner, the expected long term resources available to the partner, and the skills and

capabilities of the partner.

Through coordination with our PEPFAR and CDC Uganda Program unit we have developed an in depth

understanding of Uganda's infrastructure and our partner's resources, capabilities and desires. CDC

Informatics has a number of highly skilled, well educated individuals who understand our mission is to assist

our partners in developing there capabilities and abilities. For the most part our partners have become

capable of maintaining the initial less complicated data base and data entry systems. They recognize the

need for better data quality control, and better reporting tools.

We have partners that are using and tracking thousands to a little over a hundred thousand patients.

The Uganda infrastructure is lacking in reliable power and computer connectivity systems. Some areas

have no access to internet, telephone or power. Developing systems that allow these areas to be included

in surveillance system will require multiple capability systems that are standardized. Multiple parties

working independently on the same problems often create incompatible systems which reduces efficiency

and causes

In following activities initiated in FY05, FY06 and FY07, the Informatics Unit will focus on the following key

areas in FY08: investigate and where applicable develop computer related capabilities such as biological

patient recognition, computer power sources, and hand held computers which support our public health

partners, support the MOH resource center development of computer capacity for national data collection

and reporting; connectivity and computer infrastructure from internet access to specific network topology

design and implementation; applications development for the creation of standard information systems and

tools for management and clinic facilities; development and design of SI collection instruments; data entry

and management; analysis and reporting of SI; and, information and infrastructure security and

maintenance. Training in each of these areas will also be developed and supported either directly by the

CDC Informatics team or through utilization of outside resources and partners. The goal of training and

technical support provided will be to build capacity in partners to implement and maintain their own HMIS

with limited on-going technical support from CDC. Technical assistance will also be provided in the

interconnectivity of MIS for all partners into the national HMIS and USG systems where required or relevant.

Finally, the CDC Informatics Unit will conduct on-going SI needs assessments of partners to ensure

informatics resource growth to match needs necessitated by increasing care and prevention activities. The

increases in demand reflect the success in implementing initial programs since the partners have used

these initial systems and by passed the systems capacity. This activity works closely with MEEPP to

maximize synergies and avoid duplication.

Funding for Management and Operations (HVMS): $5,958,764

The HHS/CDC Uganda Management and Staffing (M&S) budget for FY 2008 supports the USG goal for

appropriate staffing and level of effort in order to provide technical assistance, programmatic oversight, and

performance monitoring for all implementing partner activities. Over 80 percent of CDC operations and

staffing costs are covered through GAP funding, and the balance is covered by GHAI funds. The GHAI

funds support direct technical assistance to in-country implementing partners for strengthening national

surveillance and policy initiatives, developing laboratories services, improving care and treatment programs,

expanding counseling and testing approaches, enhancing PMTCT activities and TB/HIV integration, and

implementing public health evaluations.

The HHS/CDC Uganda staffing plan includes nine approved U.S. Direct Hire (USDH) staff positions: Chief

of Party; Associate Director for Operations; Program Manager; three unit Chiefs for Laboratory Services,

Behavioral Science, and Informatics; and three Medical Epidemiologists. One new USDH position is

planned for an Associate Director for Science (ADS). Two Title 42 Senior Service Fellows (SSF) are also

requested. One will work with the Ministry of Health's (MOH) national prevention of mother-to-child HIV

transmission (PMTCT) Coordinator and the Tororo District Hospital; with a focus on best practices and

national policy to address technical, operational, and organizational PMTCT program implementation. The

other will focus on enhancing and integrating public health surveillance, improving MOH monitoring and

evaluation activities, and strengthening collaborations between the President's Malaria Initiative (PMI) and

PEPFAR/Uganda implementing partners, technical units, and surveillance programs. Three Personal

Services Contract (PSC) positions are also planned. These five positions are necessary for HHS/CDC to

continue the provision of high quality technical assistance to and strengthening of indigenous partners'

capacity, to ensure the sustainability of PEPFAR activities as support for this technical assistance was

previously provided under different mechanisms.

As shown in the organizational charts provided, the HHS/CDC Uganda office is comprised of six units:

Operations, Program, Laboratory, Epidemiology, Informatics, and Behavioral.

The Program Unit works with PEPFAR-supported partners to provide technical assistance for program

implementation and to ensure that implementing partner initiatives are based on current evidence-based

science. Direct country project officer oversight is in place for seven of ten active PEPFAR treatment

partners: Makerere University Faculty of Medicine, The AIDS Support Organization, Mildmay Center, Reach

-Out Mbuya, Rakai Health Services, Pediatric Infectious Diseases Clinic, and Catholic Relief Services-AIDS

Relief. These partners work in over 60 public and non-governmental organization (NGO) facilities, treat

46,000 clients and provide care to 134,000 HIV-infected persons and their families Currently, CDC has

twenty-five local and central cooperative agreements supporting a broad range of predominantly indigenous

partners. Partner activities include implementation of HIV prevention interventions, laboratory services,

blood safety activities, TB/HIV integration, care and treatment for adults, and for orphans and vulnerable

children (OVC), PMTCT program expansion, strategic information initiatives and capacity-building/system

strengthening interventions. HHS/CDC also provides direct funding and technical support to the MOH and

the National Medical Stores (NMS). In FY 2008, funding opportunity announcements will likely add three to

five new implementing partners by July 2008.

The Laboratory Unit provides technical support to the national Central Public Health Laboratory and national

reference laboratories for virology, TB, and blood safety; and provides training for implementing partner

staff. The CDC laboratory works closely with the MOH to review and develop appropriate laboratory

diagnostic technologies for HIV disease monitoring, and has developed less expensive CD4 and viral load

tests for use in resource-poor settings. The laboratory performs HIV-related tests in-country, including

CD4/CD8 and viral load counts, dry-blood spot testing for the Early Infant Diagnosis program, and routine

clinical testing for serology, hematology and clinical chemistry for the HBAC cohort and implementing

partners. The laboratory also conducts routine quality control testing on specimens from the door-to-door

initiatives and is currently transferring this technology to the national HIV reference laboratory. The CDC

laboratory also provides training placements for students from national laboratory training programs. In

addition, the laboratory liaises with other virology reference laboratories and CDC Atlanta on investigations

of viral hemorrhagic fever and other suspected country-wide viral outbreaks, and with the Ugandan national

avian influenza preparedness program. An accreditation process through The American College of

Pathologists is underway, which will certify the CDC laboratory as a high-level testing and training facility for

Uganda and the East Africa region.

The Epidemiology Unit leads the implementation of twelve public health evaluations (PHEs). Currently, the

team has seven approved PHEs in development: the impact of ART on morbidity, mortality and HIV

transmission and household economics; TB drug resistance; HIV surveillance among high-risk groups;

assessing the utility of retesting HIV sero-negative voluntary counseling and testing clients; evaluating the

impact of home-based counseling; exploring the interface between pediatric malaria, HIV, and

cotrimoxazole prophylaxis; and, incidence-based HIV surveillance. Three new PHEs are proposed for FY

2008; two will focus HSV-2 and one for evaluating treatment adherence interventions. This team also

provides the MOH AIDS Control Program direct technical assistance to conduct antenatal clinic

surveillance, and for the development and conduct of the AIDS Indictor Survey. Scientists in the unit are

key members of the national Technical Surveillance workgroup and the PEPFAR strategic information

workgroup and PHE task force. They also advise the MOH and related government agencies on national

evaluations and studies.

In addition, Epidemiology Unit staff coordinates the Tororo field station Home-Base AIDS Care I (HBAC)

project. HBAC is an approved PHE designed to answer key operational questions that will provide valuable

information to the MOH and inform the international community on how to best scale-up ART in rural

settings; develop appropriate policies for selection of second line ART drug regimens; evaluate the need for

continued cotrimoxazole in ART patients; and, examine the risks and benefits associated with early versus

late ART drug switching.

The Informatics Unit provides Ugandan public health partners with computer system expertise, performs

CDC laboratory data management, and provides in-country scientific staff with data management and

statistical support. This team also provides technical assistance to the MOH Resource Center in the design

and implementation of the national Health Management Information System and provides direct technical

assistance to over twenty local implementing partners on data collection applications for clinical and

laboratory services, data management and analysis, and the building, maintenance, and management of

electronic communication, connectivity and data networking systems. The Informatics Unit provides

extensive on-site training opportunities for all HIV partners to strengthen their institutional capacities, and

holds on-campus training sessions on Epi-info, SQL, network management; trainings are also available for

staff, MOH and partners on management of national survey data.

The Behavioral Unit provides scientific leadership to numerous indigenous partners, including the MOH,

NGOs, universities, other PEPFAR country units, USG agencies, and various international health

institutions. Using multidisciplinary methods based on behavioral science, anthropology, economics, and

Activity Narrative: epidemiology, the Unit also provides direct technical assistance and capacity building to a variety of

partners. The goals of the Unit are to address issues and reduce barriers relevant to providing effective HIV

prevention and care services. These include: PMTCT implementation and program harmonization;

changing risk behavior to reduce secondary HIV transmission; reducing social and stigma associated with

HIV testing and home-based care; evaluating reproductive norms and reducing unwanted pregnancies

among HIV-infected women; increasing social support for care and disclosure; facilitating discordant couple

counseling; and, interventions for OVC. The Behavioral Unit is planning new projects to address prevention

and care in the Uganda Prison System, and to develop and facilitate policy-level interventions.

To fully implement the activities described above, the HHS/CDC office has planned for a full compliment of

248 staff positions, including the six planned technical experts described above. These staffing needs are

supported by increased funding for PMTCT, laboratory services, and strategic information to ensure

adequate technical assistance for expanded initiatives, surveillance activities, and data management and

analysis of the PHEs.

M&S staff-specific costs include travel, training, and communication services. The M&S operational costs

are inclusive of office and warehouse space, and associated utility and security costs. The $552,250 M&S

cost is for procurement of information technology support services from Atlanta. ICASS charges of $1.2

million cover the USDH staff, relocation fees, residential leases and maintenance and security services.

CSCS charges of $320,000 are budgeted as required by COP08 guidance.