Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 7207
Country/Region: Uganda
Year: 2008
Main Partner: Joint Clinical Research Center
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $10,065,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $300,000

This activity is a follow-on of the Joint Clinical Research Center (JCRC)-Time Table for Regional expansion

of Anti-Retroviral Treatment (TREAT). This transition to a new mechanism will be completely seamless, with

no interruption to on-going activities. In FY2008, this activity will focus on training health workers,

strengthening and mentoring regional hospitals, districts, private sector including faith-based institutions and

other anti-retroviral therapy (ART) providers to scale-up ART services district-wide, and infrastructure

development for increased clinical space for ART in rural health centers and improved laboratory

infrastructure and services for diagnosis and monitoring of treatment for tuberculosis(TB) and HIV

In an effort to integrate delivery of interventions for Prevention of Mother to child Transmission (PMTCT)

within maternal and child health services(MCH), the TREAT program will scale-up the use of highly active

anti-retroviral (ARVs) for treating pregnant women and preventing HIV-infection in infants in 60 supported

sites. The program will provide HIV/AIDS Counseling and Testing (HCT) and CD4+ cell measurement

services to at least 10, 000 HIV-positive pregnant women in 60 sites to determine anti-retroviral therapy

(ART) eligibility and provide ART to those eligible. It is estimated that 30 percent of these women will

receive ART services.

The program will provide support and training to other USG-supported program to integrate CD4+ cell

measurement in the essential package for pregnant women and setup referral networks to ensure that

health facilities without CD4+ cell measurement facilities send samples to referral laboratories.

In addition to training staff in MCH services to provide ART, the program will procure and provide ARVs to

antenatal clinics in 60 sites. The program will also ensure that AZT and Nevirapine for infants is available in

the 60 MCH sites.

It is estimated that 3,000 HIV-positive pregnant women with CD4 cell count below 350cells/mm³ will receive

ART while 7,000 not yet eligible for ART will receive a course of highly effective ARVs for prevention of HIV

infection in infants. All the 10,000 HIV-exposed infants will receive a 7-day course of zidovudine (AZT) and

nevirapine. The program will follow the revised Ministry of Health protocol for PMTCT and the WHO

recommendations for ARV drugs for treating pregnant women and preventing HIV-infection in infants in

Resource-limited setting.

It is anticipated that through this activity, PMTCT using single dose Nevirapine will be reduced to an

absolute minimum in the supported sites.

The program will link with the President's Malaria Initiative (PMI) to provide Intermittent Preventive Therapy

for malaria in pregnancy using either daily cotrimoxazole or 3-doses of sulfadoxine-pyrimethamine and the

distribution of Insecticide Treated Mosquito nets to pregnant mothers. All women diagnosed to be HIV-

positive will be screened for tuberculosis (TB) and receive nutritional counseling and education including

support for infant feeding. All women eligible will receive cotrimoxazole prophylaxis.

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

This activity is a follow-on of the Joint Clinical Research Center (JCRC)-Time Table for Regional expansion

of Anti-Retroviral Treatment (TREAT). This transition to a new mechanism will be completely seamless, with

no interruption to on-going activities. In FY2008, this activity will focus on training health workers,

strengthening and mentoring regional hospitals, districts, private sector including faith-based institutions and

other anti-retroviral therapy (ART) providers to scale-up ART services district-wide, and infrastructure

development for increased clinical space for ART in rural health centers and improved laboratory

infrastructure and services for diagnosis and monitoring of treatment for tuberculosis(TB) and HIV.

In the selected 25 focus districts and over 60 sites, the program will provide palliative care services to

15,000 clients not yet eligible for ART. This brings the total number of patients under care including those

on ART to over 45,000. The program will provide clinical care services including diagnosis and treatment of

opportunistic infections(OIs), nutritional assessment and counseling, psychosocial support and screening

for ART eligibility. Patients under palliative care will be screened for tuberculosis and those diagnosed with

TB will receive treatment. The program will provide a comprehensive preventive basic care package to the

10,000 clients under care.

The program will train and support 120 expert clients from 60 groups of People Living with HIV/AIDS to

facilitate referrals and linkages between facility-based and community based care. The groups will facilitate

referrals to warp around services available in the communities. 900 health workers will be trained to provide

palliative care services.

The program will scale-up TB/HIV integration activities including setting facility infection control procedures

in facilities supported, provider-initiated counseling and testing for TB-registered clients and ensuring

referral and retrieval referrals between TB and HIV clinics and services.

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

This activity is a follow-on of the Joint Clinical Research Center (JCRC)-Time Table for Regional expansion

of Anti-Retroviral Treatment (TREAT). This transition to a new mechanism will be completely seamless, with

no interruption to on-going activities. In FY2008, this activity will focus on training health workers,

strengthening and mentoring regional hospitals, districts, private sector including faith-based institutions and

other anti-retroviral therapy (ART) providers to scale-up ART services district-wide, and infrastructure

development for increased clinical space for ART in rural health centers and improved laboratory

infrastructure and services for diagnosis and monitoring of treatment for tuberculosis(TB) and HIV.

In the selected 25 focus districts and over 60 sites, the program will train 300 health workers to diagnosis

and manage TB/HIV co-infection.

5,000 TB/HIV co-infected patients will be identified, treated for TB and given cotrimoxazole prophylaxis. The

program will implement infection control procedures at all the 60 service outlets.

The program will train and support 120 expert clients from 60 groups of People Living with HIV/AIDS to

facilitate referrals and linkages between facility-based and community based TB and HIV management. The

groups will facilitate referrals to wrap around services available in the communities. 900 health workers will

be trained to provide TB/HIV services. It is estimated that in FY2008, the program will provide anti-retroviral

therapy to 1,000 TB/HIV co-infected clients.

The program will scale-up TB/HIV integration activities including setting facility infection control procedures

in facilities supported, provider-initiated counseling and testing for TB-registered clients and ensuring

referral and retrieval referrals between TB and HIV clinics and services.

Funding for Treatment: ARV Drugs (HTXD): $3,000,000

This activity is a follow-on of the Joint Clinical Research Center (JCRC)-Time Table for Regional expansion

of Anti-Retroviral Treatment (TREAT). This transition to a new mechanism will be completely seamless, with

no interruption to on-going activities. In FY 2008, this activity will focus on strengthening and mentoring

regional hospitals, districts, private sector including faith-based institutions and other anti-retroviral therapy

(ART) providers to scale-up ART services district-wide.

The program will provide training of over 1,000 health workers in 30 districts in ARV logistics and

procurement focusing on forecasting, warehouse management and distribution of ARVs. The program will

strengthen the Directorate of District Health Services in the 30 focus districts in ARV drugs procurement and

distribution and reporting to Ministry of Health.

The program will procure ARVs to cater for over 20,000 patients on first line treatment and 5,000 on second

line. The program will also procure a buffer stock to respond to emergency stock-outs of ARV in the public

health sites. The program will introduce a pharmacy dispensing tool to capture and report on clients

accessing ARVs, track patients and report on treatment outcomes. Opportunities of introducing a Smart

Card will be looked at during this financial year.

Funding for Treatment: Adult Treatment (HTXS): $4,800,000

This activity is a follow-on of the Joint Clinical Research Center (JCRC)-Time Table for Regional expansion

of Anti-Retroviral Treatment (TREAT). This transition to a new mechanism will be completely seamless, with

no interruption to on-going activities. In FY2008, this activity will focus on training health workers,

strengthening and mentoring regional hospitals, districts, private sector including faith-based institutions and

other anti-retroviral therapy (ART) providers to scale-up ART services district-wide, and infrastructure

development for increased clinical space for ART in rural health centers and improved laboratory

infrastructure and services for diagnosis and monitoring of treatment for tuberculosis(TB) and HIV.

The program will train physicians and non-physicians to provide ART services. The program will also

support groups of People Living with HIV/AIDS (PHAs) to provide services as expert clients in the health

facilities and in the community. PHAs will facilitate referrals and linkages between facility-based and

community-based care, ART literacy, food and nutrition support, support for adherence to anti-retrovirals

(ARVs), counseling for prevention with positives and linkages to basic preventive package and wrap-around

services.

In the selected 25 focus districts and over 90 sites, the program will support infrastructure development for

ART services and build capacity of the Directorate of Health Services to manage ART services in the

district. The program will provide technical and financial support for districts to carry out quarterly support

supervision activities. It is estimated that a total of 6,000 new patients will be initiated on treatment bringing

the total number of patients supported to over 24,000.

Critical emerging issues like adherence, surveillance for resistance, Infant Diagnosis using DNA-PCR and

screening of patients under palliative care for ART eligibility will be supported. The program will provide

financial support in form of grants to Civil society organizations and Networks of PHAs to carry out activities

that support improved ART literacy, adherence, patient tracking, prevention with positives and linkages to

wrap around services.

A key area of focus for this program will be support for the scale-up of access to ART for pregnant women

by ensuring that ARVs are available in the ante-natal clinics and that staff in the antenatal clinics are trained

to counsel, initiate and manage ART in pregnant women. The program will also work closely with the

maternity ward and pediatrics unit to identify HIV-exposed and infected children, provide infant-diagnostic

services and provide care and ARVs for those that are eligible.

The program will scale-up TB/HIV integration activities including setting up facility infection control

procedures in facilities supported, provider-initiated counseling and testing for TB-registered clients and

ensuring referral and retrieval referrals between TB and HIV clinics and services.

In FY2008, the program will continue to support the Department of Defense (DOD) ART programs through

Walter Reed in Kayunga district and Uganda People Defense Forces (UPDF) in Gulu, providing ART to

2,000 additional clients.

In conjunction with Supply Chain Management Systems (SCMS), the program will continue to explore the

introduction of the Smart Card and an ART Dispensing Tool in all public health ART sites. This will improve

patient tracking.

To complement these efforts, this new activity will also focus on integrating family planning and HIV/AIDS

services. Such integration has the potential to create synergistic relationships between programs, reduce

missed opportunities, and ultimately maximize the effectiveness and impact of services by providing

comprehensive reproductive health care that holistically addresses clients' dual risks of HIV infection and

unintended pregnancy. With increased access to HIV/AIDS treatment, more people living with HIV/AIDS are

regaining their sexual activity. Among HIV-infected women, the prevented of unintended pregnancies is

essential and highly cost-effective for prevention mother-to-child transmission of HIV and reducing the

number of children orphaned when parents die of AIDS-related illnesses.

The program will develop programmatic strategies for strengthening linkages between family planning and

HIV/AIDS services such as voluntary counseling and testing (VCT), prevention of mother-to-child

transmission (PMTCT), and antiretroviral treatment (ART). This activity will leverage USAID funding for

family planning and ensure that linkages between HIV/AIDS and family planning are established and

institutionalized.

The program will disseminate the recently developed tools and materials that contain guidance for providers

who offer contraceptive counseling to clients with HIV, including those on ARV therapy. The information will

be designed to be used in a variety of settings by providers who regularly offer family planning services and

by those who want to begin integrating contraceptive services with HIV treatment and care services.

300 health workers will be trained to integrate family planning in HIV/AIDS care and treatment services.

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

This activity is a follow-on of the Joint Clinical Research Center (JCRC)-Time Table for Regional expansion

of Anti-Retroviral Treatment (TREAT). This

transition to a new mechanism will be completely seamless, with no interruption to on-going activities. In

FY2008, this activity will focus on training health

workers, strengthening and mentoring regional hospitals, districts, private sector including faith-based

institutions and other anti-retroviral therapy (ART)

providers to scale-up ART services district-wide, and infrastructure development for increased clinical space

for ART in rural health centers and improved

laboratory infrastructure and services for diagnosis and monitoring of treatment for tuberculosis (TB) and

HIV.

In the 25 focus districts, the program will provide support to the Directorates of District Health Services

(DDHS), six regional hospital laboratories and

over 60 primary health centers to provide laboratory services for improved laboratory testing for diagnosis of

HIV infection and other opportunistic infections

and for monitoring patients during care and treatment. Through the DDHS office, the program will support

the establishment of effective laboratory networks

in the focus districts. The program will build the capacity of the district hospitals to provide laboratory

support to lower health centers (HCIVs, HCIII and HCII) through referral testing and support supervision.

The program will build capacity of the district hospital to provide quality assurance and train laboratory

personnel.

At least 10 of the 60 health facilities will be designated as regional referral hubs for CD4+ testing and infant

diagnosis and two centers for viral load

and TB culture. In addition the program will support at least six regional centers to a status of a Regional

center of Excellence to provide highly specialized

HIV and TB diagnostic testing and support supervision. In FY2008, the program will train over 100 non-

laboratory technicians to carry out microscopy

work in the laboratories and also provide in-service training for 100 laboratory technicians.

Through support to the districts the program will generate support from the local government structures and

provide an environment for a sustainable long-term impact. The program will provide financial and technical

support to the District Directorate of Health Services (DDHS) to provide support supervision to health

workers in the district and monitor establishment of a tiered-quality-assured laboratory networks in the focus

districts.