Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 1257
Country/Region: Uganda
Year: 2009
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 Laboratory Infrastructure (HLAB): $346,606


This funding supports the USG goal of appropriate staffing and level of effort in order to provide technical

assistance, programmatic oversight and performance monitoring for all implementing partner (IP) activities.

Over 80% of CDC operations and staffing are covered through GAP funding and the balance is covered by

GHAI funds. In the lab sector, GHAI funds are used to support implementing partner activities. The

HHS/CDC Uganda office is comprised of six units; Operations, Program, Laboratory, Epidemiology,

Informatics and Behavior.

In FY 2008, the CDC lab unit continued to provide support for diagnostic testing, logistics management,

national and international technical and management training and workshop/conference attendance for

CDC projects and for IPs. Diagnostic testing in the CDC lab included 31,361 HIV serological tests, mostly

for quality control testing in support of full-access HBCT in two Districts, 5,781 viral load tests, 1,602 HIV

DNA tests (for exposed infants), 287 serum chemistries, 19,002 CD4+ counts and 7,498 complete blood

counts. The evaluation of immune activation markers as surrogates for viral load became possible with the

gift of an LSR II flow cytometer that allows up to 10 phenotypic markers to be investigated on a single

immune cell and potentially makes HIV disease monitoring simpler and cheaper. An Ampliprep for

automated nucleic acid extraction from plasma, whole blood and dried blood spots was procured for viral

load and especially for HIV DNA PCR for infants. This will add capacity to the national Early Infant

Diagnosis (EID) program that currently only has 7 testing centers countrywide, allowing faster turnaround

times. CDC-Uganda maintained substantial stocks of lab commodities including HIV rapid test kits to offset

national stock-outs and also directly supplied a number of partners with CD4+ count tests - currently the

National Medical Stores has insufficient capacity to manage diagnostic tests for ART eligibility and disease

monitoring. A new approach to the quality assurance of HIV serology in the country was validated by the

CDC lab based on dried serum samples. A number of CDC staff completed B.Sc. and M.Sc. graduate

courses and CDC and partner lab staff participated in training courses in good lab practice, lab

management and technical training to improve their own training skills. The CDC lab, working with the

PEPFAR Lab TWG and the national Lab Technical Committee (LTC), continued to strengthen national lab

systems by: direct hiring of program staff under the MOH/AIDS Control Program CoAg, including lab

personnel, instead of paying existing MOH staff supplementary allowances thus ensuring full-time attention

to CoAg activities; assigning two full-time CDC staff to the Central Public Health Laboratory (CPHL) to

provide leadership and mentoring for the national Laboratory Training Coordination and Quality Assurance

(QA) units - activities included the continued roll-out of the HIV rapid test training package towards the goal

of 3,500 technicians trained, the roll-out of the TB smear microscopy training package and the identification

of 64 sites with CD4+ count capacity, mapping their locations by GIS for networking of services, enrolling

them in an EQA scheme (NEQAS) and training them in it's use; providing a senior Technical Advisor to

MOH to help finalize and implement the National Laboratory Services Policy and create a

Department/Division of Laboratory Services within MOH to oversee it's implementation; supporting the

national lab commodities credit line at the National Medical Stores (government) and Joint Medical Stores

(NGO) that provides basic lab commodities to over 1000 laboratories in the country; overseeing the building

and renovation of (20) laboratories at lower health facility levels, (2) blood banks and a new CPHL (not yet

started); supporting technical and management training (SMDP) through the OGAC-Becton Dickinson

Public Private Partnership and GAP/CDC Atlanta in CD4+ EQA, TB smear microscopy and TB specimen

referral; funding the HIV Reference Lab at the Uganda Virus Research Institute (UVRI) to conduct national

QA for HIV serology and to validate new HIV serological assays and testing algorithms, facilitating the

national QA program for TB smear microscopy and establishing a national TB specimen referral system

with POSTA Uganda for re-treatment cases through the National TB Reference Lab (NTRL); renovating the

training lab and clinical laboratories at NTRL to provide a safe environment for MDR/XDR culture and

resistance testing; establishing a lab information management system (LIMS) at CPHL and in collaboration

with the CDC Informatics Unit, providing support to both CPHL/MOH for databases on technicians' training

history and lab commodities management and the DHOs, for HMIS and mobile telephony to help coordinate

activities within the lab sector and with the MOH Resource Centre and, collaborating with MOH in the

design of the 2009 national HIV/Malaria Indicator Survey (UMAIS).

In FY 2009, the CDC-Uganda lab will continue to service CDC and partner lab needs, including the

establishment of lab capacity in partner laboratories coupled with continued monitoring by the QA unit at

CPHL. Dried blood spot testing by HIV DNA PCR for the national EID program will be expanded and the

EID monitoring unit at CPHL strengthened. Immuno-phenotyping to monitor disease progression will be

further explored for the Tororo Child Cohort study following the acquisition of an LSR II flow cytometer. The

national STI lab will be strengthened through technical and financial support channeled through the CRANE

survey. Lab testing for a further two PHEs, one on incidence testing by pooled PCR and the other on ‘the

last 1000 infections' will be completed. Diagnostic testing capacity at the CDC lab in Tororo Hospital will be

expanded to include CD4+ counts, complete blood counts (CBC) and serum chemistries while a new lab,

currently under construction, will be completed to support both HBAC and a number of new initiatives

including the Pre-Exposure Prophylaxis Study, funded by the Gates Foundation. The College of American

Pathologists will inspect the CDC Entebbe lab for accreditation in late 2008. Under national lab systems

strengthening activities, there will be renewed emphasis on increasing the District Health Officer's (DHO)

engagement with the lab sector - IPs will be encouraged to provide both technical and financial support to

the DHO directly which is in line with PEPFAR Uganda's plans for competitive Partnership Compacts. With

the hiring of a TA to work alongside the Director of Clinical and Community Health at MOH, the National

Health Lab Policy, currently in it's second draft, will be completed. The TA will work with senior MOH

officials to develop a five-year implementation plan for the policy. A further responsibility for the TA will be

to act as a full-time liaison between the PEPFAR Lab TWG and the non-government IPs - the latter have

tended to develop vertical programs in the lab sector, duplicating national activities such as procurement,

training, quality assurance and infrastructure development which are the responsibility of MOH/CPHL. IPs

have now been asked to work more closely with MOH/CPHL and to include in their activity narratives,

details of proposed spending on equipment, commodities and salary support for lab-related staff. The

strengthened CPHL will house both traditional CPHL activities including environmental health and hygiene,

outbreak investigation, etc. and also coordination activities in support of national health lab systems

including; infrastructure development (20 additional lower health-facility laboratories will be built/renovated,

3 of the remaining 5 blood banks will be renovated and the building of the new CPHL will be started, GIS

mapping of health facilities for the whole country to facilitate networking of services, instrument

maintenance contracts with vendors consolidated); human resources (3,500 HIV serological testing

Activity Narrative: providers trained, continued roll-out of both the TB smear microscopy and TB specimen referral training and

lab management training); logistics management (increased funding to NMS, updated commodities

management software tools, national training in logistics management, monitoring lab logistics distribution);

quality assurance (extend CD4+ count EQA to all facilities with capacity, expand HIV serological QA to all

sites using proficiency testing (DTS PT) panels, introduce EQA for CBC and serum chemistries at sites with

capacity); support supervision (facilitate DHO to support Regional Lab Coordinator and District Lab Focal

Person, facilitate central and zonal supervisors with vehicles); informatics (implement mobile telephony at

lower-level health facilities, provide hardware for CPHL informatics and additional staff, liaise with MOH RC

on coordination); infection control (coordinate activities with AMREF). The long-term objective is that staff

employed at CPHL to strengthen national health lab systems will naturally transition into a

Department/Division of Lab Services within MOH - the positioning of the new CPHL building adjacent to

MOH should facilitate this transition. Under the OGAC-BD PPP, the CDC lab will provide continued

technical support for CD4+ count EQA and management training to the remaining 30+ sites, support NTRL

to roll-out the WHO/CDC national training program in AFB smear microscopy and extend the national TB

specimen referral system beyond the Kampala District - a toll-free telephone line to POSTA Uganda will be

set up to allow facilities to call in when there are specimens to be collected. The only new activity in 2009

under PEPFAR funding will be support for the HIV Drug Resistance secretariat based at UVRI and for

HIVDR surveillance, funded through an existing CoAg with UVRI. The CDC-Uganda lab will continue to

play an active role in the preparation, funding and implementation of the 2009 UAMIS. New developments

at UVRI in 2008/9 are the collaboration between CDC (NCZVED) and UVRI on the establishment of a

center for Infectious Diseases Ecology that will encompass prevention, detection, surveillance and control of

new and emerging infectious agents including plague, arboviruses, influenza, hepatitis E and viral

hemorrhagic viruses and, the proposed biotechnology unit, a collaboration between Inverness Medical

Innovations and UVRI, for both of which, CDC-Uganda staff will provide TA.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13341

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13341 4429.08 HHS/Centers for US Centers for 6446 1257.08 CDC Base GAP $981,732

Disease Control & Disease Control

Prevention and Prevention

8376 4429.07 HHS/Centers for US Centers for 4820 1257.07 CDC Base GAP $1,400,000

Disease Control & Disease Control

Prevention and Prevention

4429 4429.06 HHS/Centers for US Centers for 3347 1257.06 CDC Base GAP $1,315,300

Disease Control & Disease Control

Prevention and Prevention

Emphasis Areas


* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* TB

Military Populations

Refugees/Internally Displaced Persons

Workplace Programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Table 3.3.16:

Funding for Strategic Information (HVSI): $840,816


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

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

partners, including the Ministry of Health. Some of these service providers are funded by PEPFAR, and

CDC Informatics Staff provide all of them with direct, hands-on support 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.

Through coordination with the PEPFAR program 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 their 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 reduce efficiency

and causes unnecessary delays. 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.

In following activities initiated in FY 2005, FY 2006, FY 2007 and FY 2008, the Informatics Unit will focus on

the following key areas in FY 2009: **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;

** 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 is aimed at building partners' capacity 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13342

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13342 4703.08 HHS/Centers for US Centers for 6446 1257.08 CDC Base GAP $899,504

Disease Control & Disease Control

Prevention and Prevention

8384 4703.07 HHS/Centers for US Centers for 4820 1257.07 CDC Base GAP $899,504

Disease Control & Disease Control

Prevention and Prevention

4703 4703.06 HHS/Centers for US Centers for 3347 1257.06 CDC Base GAP $872,000

Disease Control & Disease Control

Prevention and Prevention

Emphasis Areas


* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening



Table 3.3.17:

Funding for Management and Operations (HVMS): $6,852,578

The HHS/CDC Uganda Management and Staffing (M&S) budget for FY 2009 supports the USG goal for

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

performance monitoring for HHS/CDC funded implementing partner activities. Over 70 percent of these

CDC operations and staffing costs are covered through GAP base-funding, with the balance covered by

GHCS. The GHCS funds support direct technical assistance to indigenous local implementing partners to

strengthen national surveillance and policy initiatives, develop laboratories services, improve care and

treatment programs, expand counseling and testing approaches, enhance PMTCT activities, improve

TB/HIV integration, and implement public health evaluations.

The HHS/CDC Uganda staffing plan includes the following approved U.S. Direct Hire (USDH) staff

positions: Country Director; Deputy Director; two Public Health Advisors, one administrative and one

technical; three Senior Scientists that serve as unit chiefs for Laboratory Services, Behavioral and Social

Science, and Informatics; and four Medical Officer/Epidemiologists, one of whom serves as the President's

Malaria Initiative advisor. Three approved personal services contractors (PSCs) include a Laboratory

Services Coordinator, Behavioral Scientist, and Medical Officer/Epidemiologist for PMTCT.

For 2009, two new PSCs are requested to provide technical assistance to the Epidemiology and Informatics

Units, respectively. In addition two (1) non-PSC will support care and treatment activities in the Program

Unit, and thirteen (13) LES positions are planned. These sixteen positions are necessary for HHS/CDC to

continue to provide high quality technical assistance that strengthens indigenous partners' capacity thus

ensuring the sustainability of PEPFAR activities. As shown in the organizational charts provided, the

HHS/CDC Uganda office is comprised of seven units: Office of the Director, Operations, Program,

Laboratory, Epidemiology, Informatics, and Behavioral.

The Program Unit oversees HHS PEPFAR-supported partners and provides technical assistance for

program implementation to ensure partner initiatives are based on current evidence-based science. Direct

country project officer management 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 Sciences Program, Uganda Baylor College Foundation, and Catholic Relief Services-

AIDS Relief. These partners work in over 80 public and non-governmental organization (NGO) facilities,

treat over 65,000 clients [including 7200 pediatric patients] and provide care to 157,000 HIV-infected

persons [of which 18,000 are pediatric patients] and their families. Currently, CDC has twenty-eight 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 adult and pediatric patients, and, for orphans and

vulnerable children (OVC), PMTCT program expansion, strategic information initiatives and health systems

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

Health (MOH) and the National Medical Stores (NMS). In FY 2009, funding opportunity announcements will

likely add two to three new implementing partners.

Working with the national Laboratory Technical Committee and PEPFAR Laboratory Technical Working

Group the, CDC laboratory staff will continue to support the strengthening of the national laboratory system

by providing technical advice and financial inputs to develop and implement a national laboratory services

policy and development of the Department of Laboratory Services within MOH. Laboratories at Regional

and District Health Facilities will continue to be renovated and equipped to provide full HIV testing and

monitoring services. The new Central Public Health Laboratory (CPHL), where CDC will assign technical

staff to provide leadership and mentoring and will establish a laboratory information management system to

coordinate activities within the laboratory sector and with the MOH Resource Centre. The CDC Laboratory

Unit will continue to coordinate technical and management training through the OGAC-Becton Dickinson

Public Private Partnership in collaboration with CDC Atlanta. Quality assurance schemes for HIV serology

managed by the Uganda Virus Research Institute (UVRI) and for CD4+ counting through CPHL will also be

supported by direct technical assistance from CDC laboratory staff. Finally, CDC laboratory staff will

provide support supervision assistance to both the District Laboratory Focal Persons and Regional

Laboratory Coordinators by working in close collaboration with the District Health Officer. Other Laboratory

Unit activities include: assisting National Medical Stores to forecast, procure, store, distribute and monitor

laboratory reagents through the national Laboratory Credit Line; support for national HIV drug resistance

activities; and, collaboration with MOH in the design and implementation of national HIV/AIDS surveys. The

CDC Laboratory will also provide substantial financial and technical support to the National TB Reference

Laboratory to rehabilitate training facilities; roll-out a national training program in AFB smear microscopy;

establish a national TB specimen referral system; provide containment laboratories for the safe handling of

MDR and XDR TB strains, and conduct a national TBDR survey.

The Epidemiology Unit leads and supports the implementation of twelve public health evaluations (PHEs)

and HIV surveillance activities. Currently, the team has seven continuing PHEs:

1. Strategies to decrease HIV-transmission risk behavior and increase drug adherence among HIV-infected

adults initiating antiretroviral therapy in Uganda;

2. Evaluating the utility of re-testing HIV-negative voluntary counseling and testing clients;

3. Evaluating home-based confidential counseling and testing in Kumi District;

4. Interactions between HIV and malaria in African children;

5. Evaluating anti-tuberculosis drug resistance among smear-positive TB patients;

6. Collaborative cohort of USG-supported anti-retroviral treatment programs in Uganda to assess costs and

clinical outcomes associated with different programmatic approaches;

7. Evaluating the utility of (1) using routine program HIV testing data for surveillance, and (2) the HIV-1

incidence assay for incidence-based surveillance.

The Epidemiology Unit staff coordinates the Tororo field station Home-Base AIDS Care (HBAC) project.

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

information to the MOH and 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. HBAC has one of the largest cohort on ART that is being followed up in sub-

Saharan Africa. This field station infrastructure will be used to launch additional multi-country PHEs and

Activity Narrative: provide a training venue for other PEPFAR country staff with a less developed infrastructure.

Other PHE activities conducted by partners and supported by Epidemiology Unit staff include: Comparison

of Facility and Home-based Antiretroviral Therapy Delivery Systems; Assessing the relationship between

intimate partner violence and HIV status disclosure in Rakai District; and Evaluating two types of male

circumcision procedures. CDC Uganda will participate in four new PHEs of global significance proposed for

FY 2008.

This team also provides the MOH AIDS Control Program direct technical assistance to conduct antenatal

clinic surveillance, and to develop and conduct the combined Malaria and AIDS Indictor Survey. Scientists

in the unit are key members of the national technical Surveillance workgroup, the PEPFAR strategic

information workgroup, and the OGAC PHE task force. They also advise the MOH and related government

agencies on national evaluations and studies.

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, and network management. Trainings are also

available for staff, MOH and partners on management of national survey data. Need to add the on-going

FY 2008 activities for piloting technologies for health data collection and electronic medical records


The Behavioral Unit provides scientific leadership and technical assistance to numerous indigenous

partners, including the MOH, NGOs, universities, other PEPFAR country units, USG agencies, and various

international health institutions. The goals of the Unit are to inform the development and implementation of

innovative and effective programs addressing HIV prevention, care, and treatment by using multidisciplinary

methods based on psychology, anthropology, economics, and epidemiology. The Unit has previously

focused on reducing HIV risk behavior and transmission, PMTCT implementation and program

harmonization, reducing social harm and stigma associated with HIV testing and home-based care, ART

adherence, identifying reproductive norms and reducing unwanted pregnancies among HIV-infected

women, increasing social support for care and HIV status disclosure, developing discordant couple

counseling protocols, and informing interventions for OVC and HIV-infected children. Future activities will

address HIV epidemiology, prevention, care, and treatment within the uniformed services of Uganda with a

specific emphasis on Uganda Prison Services, identifying factors related to ART adherence among HIV-

infected children, developing task shifting approaches for male circumcision and ART initiation and care,

conducting evaluations addressing HIV risk behavior disinhibition within biomedical prevention trials of pre-

exposure prophylaxis and HIV vaccines as well as male circumcision roll-out programs.

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

261 staff positions, including the fifteen planned positions. These staffing needs are required to support the

expanded activities for PMTCT, laboratory services, and strategic information to ensure adequate technical

assistance to partners; increased surveillance activities; and additional data management and analysis for

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13343

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13343 4430.08 HHS/Centers for US Centers for 6446 1257.08 CDC Base GAP $5,958,764

Disease Control & Disease Control

Prevention and Prevention

8377 4430.07 HHS/Centers for US Centers for 4820 1257.07 CDC Base GAP $4,482,516

Disease Control & Disease Control

Prevention and Prevention

4430 4430.06 HHS/Centers for US Centers for 3347 1257.06 CDC Base GAP $3,416,366

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.19: