Detailed Mechanism Funding and Narrative

Years of mechanism: 2011 2012 2013 2014 2015 2016 2017 2018

Details for Mechanism ID: 13317
Country/Region: Uganda
Year: 2011
Main Partner: Joint Clinical Research Center
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $4,220,865

1. Overall goals and objectives

The main goal of the program is to ensure the provision of HIV/AIDS care, treatment, and laboratory services within public regional referral and district hospitals, JCRC Kampala, JCRC Regional Centers of Excellence (RCEs) and their respective communities. The focus of THALAS during this period is to ensure smooth transition of patients and services from six RCEs to respective regional referral hospitals supported by SUSTIAN. THALAS will continue to provide specialized laboratory services through seven RCEs in Kampala, Gulu, Mbale, Kakira, Fort Portal, Mbarara and Kabale. The RCEs will also be used as lab training centers and will provide external quality control services.

2. Target populations and geographic coverage The project will cover JCRC Kampala, and six Regional Centres of Excellence (RCEs) located in Kakira, Mbale, Gulu, Fort Portal, Kabale and Mbarara. The residents in the Central region (Kampala, Wakiso) and neighboring districts will be served through JCRC Kampala.

3. Enhancing cost effectiveness and sustainability THALAS program will continue to apply cost saving approaches such as task shifting. THALAS will also develop a sustainability/exit strategy for continued provision of integrated TB/HIV/AIDS services at the JCRC Kampala site.

4. Health Systems Strengthening The JCRC network of laboratories will continue to provide advanced lab services (CD4, Vial load, chemistry, hematology, and DNA PCR services). Under THALAS, JCRC DNA PCR testing for early infant diagnosis will continue to support the entire country through an MOU with MOH and PMTCT partners. JCRC will also support MoH labs with external quality control systems. Lessons learnt from JCRC's extensive experience have formed the basis for a more efficient and cost effective second generation referral system and an SMS printer system that returns results electronically and has been successfully piloted in 13 district hospitals. THALAS will coordinate with MoH, CHAI, USAID and other key stakeholders to scale-up the use of this technology so as to ensure timely return of results to health facilities so that infected children are promptly linked to care.

5. Cross-Cutting Budget Attributions a. Human Resources for Health THALAS will ensure availability of trained and qualified lab, clinical and non-clinical services personnel in the RCEs and JCRC Kampala.

b. Construction/Renovation REDACTED

c1. Food and Nutrition: Policy, Tools, and Service Delivery The project will collaborate with CHAI and the NuLife project to train service providers in nutritional supplementation with ready-to-use therapeutic feeds.

e. Education NA

f. Water In partnership with PACE Clean and safe water will be provided as part of a Basic Care Package to PLWHA.

6. Key issues: Briefly (one sentence) identify activities in each key issue that this mechanism will address. a. Health-Related Wraparounds o Child survival will be addressed through early infant diagnosis by ensuring early diagnosis and treatment of exposed and infected infants and young children.

b. Gender Gender issues will be addressed through Community Liaison volunteers and CSOs conducting community mobilization activities to promote positive behaviors such as: gender equity; couple dialogue; partner counseling and testing and disclosure.

d. Mobile Population NA

f. Workplace Programs NA

Funding for Care: Adult Care and Support (HBHC): $350,000

1. Target populations and coverage of target population or geographic area THALAS will support the 9,000 Pre-ART clients inherited from TREAT at JCRC Kampala and another 15,000 pre-ART clients at the RCEs at Kakira, Mbale, Gulu, Fort- Portal, Kabale, Mubende and Mbarara as well as clients being recruited since end of TREAT, with on-going care including psycho-social support.

2. Description of service delivery or other activity carried out THALAS will provide financial support to JCRC Kampala and the 7 Regional Centres of Excellence (RCEs) located in Kakira, Mbale, Gulu, Fort Portal, Kabale, Mubende and Mbarara to enable them provide on-going care and support for the Pre-ART clients. A comprehensive care package will be provided which will include preventive care, palliative care and prevention with positives. Through the collaborations with other partners at the implementation levels, including NuLife project, THALAS will network to ensure clients receive complementary services from other agencies. THALAS will continue to contribute financially and/or technically to such coordination mechanisms.

3. Integration with other health activities THALAS will work closely with MOH/ RRHs, Strengthening Uganda's System for Treating AIDS Nationally (SUSTAIN), and other implementing partners to ensure clients in chronic care and ART are linked to other health services such as reproductive health/family planning, nutrition services, malaria prevention and treatment.

4. Relation to the national program THALAS will implement national guidelines for adult HIV/AIDS care and treatment. The project will use national tools for data collection and reporting. The project will ensure that key changes in the national

policy and strategy are implemented in the project.

5. Health Systems Strengthening and Human Resources for Health In collaboration with MOH-NTLP, MOH-ACP, NuLife and SUSTAIN project, THALAS will support in- service/refresher training for clinic staff at the target facilities on the comprehensive HIV care package. THALAS will also ensure that qualified and trained THALAS personnel eventually transition to MoH when the project handover key activities to MoH by September 2012.

Funding for Treatment: Adult Treatment (HTXS): $1,276,137

1. Target populations and coverage of target population or geographic area THALAS will support the following number of ART clients who were previously supported under TREAT program: about 6,000 ART clients at JCRC Kampala; about 20,000 ART clients in the Regional Centers of Excellence (RCEs) at Kakira, Mbale, Gulu, Fort- Portal, Kabale, Mubende and Mbarara; and ART clients from JCRC satellites. THALAS plan to enroll new clients in line with the USG scale-up plan, subject to availability of funds.

2. Description of service delivery or other activity carried out THALAS will maintain current ART client base with essential ART and laboratory services as required throughout the transition process of TREAT clients to SUSTAIN and USG supported district-based partners. THALAS will source ARVs and OI medications from NMS and SCMS for the clients. Laboratory reagents will be accessed through the lab credit line system in Central Public Health Laboratory (CPHL). THALAS will also ensure that ART patients receive comprehensive services by collaborating and linking with other service providers such as NuLife project for nutrition and Hospice for palliative care. Adherence support will be provided and patient follow-up mechanisms will be strengthened. THALAS will also implement early warning HIV drug resistance monitoring activities and document findings.

3. Integration with other health activities A major focus area for integration will be with TB services.

4. Relation to the national program THALAS will operate within the existing policy documents and guidelines and tools developed by the MOH and ACP.

5. Health Systems Strengthening and Human Resources for Health

In collaboration with MOH-NTLP, MOH-ACP, NuLife and SUSTAIN project, THALAS will support in- service/refresher training for clinic staff at the target facilities on the comprehensive HIV care and treatment package. The staffing levels at the target sites will be revised/agreed upon with the partners mentioned above to ensure quality treatment and adherence support. The support supervision mechanism for the targeted facilities will also be strengthened to ensure compliance with MoH guidelines.

Funding for Care: Pediatric Care and Support (PDCS): $250,000

1. Target populations and coverage of target population or geographic area THALAS will support 6,807 Pre-ART children/adolescents inherited from TREAT at JCRC Kampala and another 16,053 pre-ART children and adolescents at the RCEs at Kakira, Mbale, Gulu, Fort- Portal, Kabale, Mubende and Mbarara as well as children/adolescents being recruited since end of TREAT, with on-going care including psycho-social support .

2. Description of service delivery or other activity carried out THALAS will provide financial support to JCRC Kampala and the 7 Regional Centres of Excellence (RCEs) located in Kakira, Mbale, Gulu, Fort Portal, Kabale, Mubende and Mbarara to enable them provide on-going care and support for the Pre-ART children/adolescents. A comprehensive care package will be provided which will include preventive care, palliative care and prevention with positives. Through the collaborations with other partners at the implementation levels, including NuLife project, Clinton foundation HIV/AIDS Iniative (CHAI), Uganda Women's Effort to save Orphans (UWESO), Compassion International, A-Z children's charity, THALAS will network to ensure children/adolescents receive complementary services from other agencies. THALAS will continue to contribute financially and/or technically to such coordination mechanisms.

3. Integration with other health activities THALAS will work closely with MOH/ RRHs, SUSTAIN , and other implementing partners to ensure children/adolescents in chronic care in the targeted health facilities are linked to other health services such as nutrition services, malaria prevention and treatment.

4. Relation to the national program THALAS will use the existing policy documents, training materials, guidelines and tools developed by the MOH and ACP.

5. Health Systems Strengthening and Human Resources for Health In collaboration with MOH-NTLP, MOH-ACP, NuLife and SUSTAIN project, THALAS will support in- service/refresher training for clinic staff at the target facilities on the comprehensive HIV care package.

Funding for Treatment: Pediatric Treatment (PDTX): $336,921

1. Target populations and coverage of target population or geographic area THALAS will support the following number of ART pediatric clients who were previously supported under TREAT program: 1440 children/adolescents below 15yrs in JCRC Kampala; 1983 children/adolescents below 15yrs in the Regional Centers of Excellence (RCEs) at Kakira, Mbale, Gulu, Fort- Portal, Kabale, Mubende and Mbarara; and ART pediatric clients from JCRC satellites. THALAS plan to enroll new pediatric clients in line with the USG scale-up plan, subject to availability of funds.

2. Description of service delivery or other activity carried out THALAS will implement the revised MoH guidelines for pediatric care and treatment.

3. Integration with other health activities THALAS will integrate key activities like early infant diagnosis within services like immunization, postnatal care, nutrition programs and MCH clinics.

4. Relation to the national program JCRC is lead provider in pediatric HIV/AIDS. THALAS team will continue to work with the national pediatric ART committee. THALAS will operate in line with the existing policy documents and guidelines and tools developed by the MOH and ACP.

5. Health Systems Strengthening and Human Resources for Health In collaboration with MOH-NTLP, MOH-ACP, NuLife and SUSTAIN project, THALAS will support pre- service and in-service/refresher training for clinic staff at the target facilities on the comprehensive HIV care and treatment package. The staffing levels at the target sites will be revised/agreed upon with the partners mentioned above to ensure quality treatment and adherence support. The support supervision mechanism for the targeted facilities will also be strengthened to ensure compliance with MOH guidelines.

Funding for Laboratory Infrastructure (HLAB): $1,688,536

1. Target populations and coverage of target population or geographic area THALAS will provide laboratory services to 7 ART sites in Kampala, Kakira, Mbale, Gulu, Fort Portal, Kabale, Mbarara districts. The priority target population includes current and new patients supported by THALAS and the Strengthening Uganda's System for Treating AIDS Nationally (SUSTAIN) program in 11 regional referral hospitals and 13 district hospitals. THALAS will also target 32,000 infants born to HIV positive mothers nationwide for DNA PCR tests.

2. Description of service delivery or other activity carried out THALAS aims to contribute to strengthening of the national laboratory systems, provide laboratory backstop and referral services. The JCRC network of laboratories in Kampala and the Regional Centers of Excellence (RCEs) located in Gulu, Mbale, Fort Portal, Kabale, Mbarara and Kakira will assume the role of reference laboratories for essential and specialized laboratory services. These reference laboratories will support majority of HIV care and treatment programs in Uganda, including MOH. THALAS will also provide laboratory support for HIV disease monitoring tests including 90,000 CD4 tests, 10,000 Viral load tests and 32,0000, DNA PCR tests. THALAS will provide DNA PCR services for the whole country, and support PMTCT partners. Lessons learnt from JCRC's laboratory experience has formed the basis for a more efficient and cost effective second-generation specimen referral system and an SMS printer system that has been successfully piloted in 13 health facilities. THALAS will support dissemination and scale-up of this successful approach in order to improve result turn-around time to facilities and facilitate improved linkage of infants to care.

3. Integration with other health activities Lab is a cross cutting portfolio. THALAS support on lab training, lab management and lab quality assurance will benefit other health activities.

4. Relation to the national program This activity directly support the national ARV program in HIV diagnosis and disease monitoring.

5. Health Systems Strengthening and Human Resources for Health In collaboration with MOH, CPHL and SUSTAIN project, THALAS will provide in-service training for laboratory staff. THALAS will conduct a training needs assessment, develop and implement refresher training curricula and training plan for laboratory staff in targeted ART sites.

Funding for Care: TB/HIV (HVTB): $319,271

1. Target populations and coverage of target population or geographic area THALAS will support 8 sites to integrate TB/HIV collaborative services: JCRC Kampala and 7 JCRC Regional Centers of Excellence (RCEs) at Kakira, Mbale, Gulu, Fort- Portal, Kabale, Mubende and Mbarara. The target population includes care providers and patients attending the different clinics at these sites.

2. Description of service delivery or other activity carried out THALAS will provide staff in the targeted sites with refresher training, coaching and mentorship on TB- HIV collaborative activities package. TB infection control assessment will be undertaken to inform a baseline need for infrastructure modifications to improve airflow at busy HIV/AIDS care and treatment centers. The THALAS team will print TB intensive case finding (ICF) forms, and other tools for use at the facilities and will ensure clients attending these facilities will be routinely screened for TB at each visit. Collaboration to refer HIV patients diagnosed with TB for DOTS already exists with TB clinics in the Regional Referral Hospitals (RRHs) where the RCEs are located. Where feasible, TB drugs will be made available within the RCE clinics.

3. Integration with other health activities THALAS will work closely with MOH/ RRHs, SUSTAIN, and other implementing partners to ensure integration of TB-HIV services in the targeted health facilities.

4. Relation to the national program The existing NTLP data collection, collation, use, and reporting systems at the district and lower levels will be used in the implementing sites (RCEs and Kampala) for purposes of sustainability. THALAS will continue to tap into the NTLP supply chain for TB diagnostics, including reagents and other supplies.

5. Health Systems Strengthening and Human Resources for Health In collaboration with MOH-NTLP, MOH-ACP and SUSTAIN project, THALAS will support in- service/refresher training for clinic staff on the TB-HIV collaborative package. Other mechanisms like task shifting will be employed where appropriate.