UVRI will contribute to the National Strategic Plan objective of reducing HIV incidence, through increasing knowledge of HIV status, and reducing risk of HIV transmission and acquisition. The overall project goal is to improve the effectiveness of HIV prevention in Uganda by enhancing comprehensive HIV prevention services amongst female sex workers (FSW) and their male partners. The objectives are: a) To increase reported risk reduction practices by high risk women and their partners in Kampala, b) To increase awareness and understanding of condom use and alcohol abuse c) To increase awareness of HIV risk and vulnerability of high risk women and their male partners, policy makers and stakeholders in Kampala; d) To develop an Enhanced Prevention Project to include a detailed M&E framework. Objectives are responsive to the Global Health Initiative principle on women, girls, gender equality and MARPS. UVRI will build on the past experience with Good Health for Women Project to provide biomedical, behavioral and structural interventions to FSWs and their paying and non-paying partners in Kampala. The proposed package of interventions will be delivered at the individual, dyadic and community levels. UVRI will strengthen and/or build partnerships with other groups working closely with FSWs. These partnerships will facilitate processes for provision of required wrap around services. UVRI will also work closely with the community and policy makers. Continuum of response will be strengthened using linkage facilitators across different service points. UVRI will develop and implement a functional information system that focuses on monitoring; risk behavior among MARPS, active follow-up, and referrals for services.

PEPFAR will focus on supporting the Government of Uganda (GOU) to further expand access to HIV care and support with the goal to achieve universal access of 80% in care by 2015. The UVRI clinic will support the provision of care services to 1,514 adults as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services. This target was derived using burden tables based on Kampala district HIV prevalence and treatment need. This program will provide services in one clinic to commercial sex workers and their family members in Kampala district. The UVRI clinic will be expected to implement approaches to promote an effective Continuum of Response (CoR) model and monitor key indicators along the continuum. The clinic will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthen positive health dignity and prevention services, implement quality improvement for adherence and retention, pain and symptom management and provide support to targeted community outreach activities in high prevalence hard to reach and underserved areas.

Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation, in line with MoH guidance. This has been a major bottleneck to treatment scale up nationally. UVRI will support the sample referral network in line with this national CD4 expansion plan; and will monitor and report clients access to CD4 in quarterly reports. In addition, they will need to regularly keep track and report on client waiting lists.

UVRI will liaise with PACE and UHMG for provision and distribution of basic care kits and family planning commodities to clients respectively. The clinic will get its Cotrimoxazole and laboratory reagents supplies from Medical Access Uganda Limited.

In addition, UVRI will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services.

UVRI will work under the guidance of MoH/ACP and Quality Assurance Department for trainings, mentorship and support supervision. The program will be aligned to the National Strategic Plan for HIV/AIDS (2011/12-2014/15.

The Enhanced Prevention OVC program aims to improve the quality of life of OVC under the care and support of the Female Sex Workers households through improving OVC livelihoods. The program will support provision of food and nutritional support, and economic empowerment of OVC households. The strengthened economic situation of the households will have a trickle-down effect on other OVC core program areas like education and health. Where appropriate children will be linked to other services within or outside the catchment area of this program. The program will reach 400 OVCs during the first year of its implementation.

UVRI will focus on supporting the GOU to scale up TB/HIV integration, and specifically the PEPFAR goal to achieve TB screening of 90% (731,690) of HIV positive clients in care.

UVRI will improve Intensified Case Findings (ICF) and the use of the national ICF tool, as well as, improve diagnosis of TB among HIV positive smear negative clients, extra pulmonary TB and pediatric TB through the implementation of new innovative technologies-GeneXpert and fluorescent microscopy. UVRI will support MDR-TB surveillance through sputum sample transportation to Gene pert hubs and receipt of results at facilities.

The MOH/ACP and National TB and Leprosy Program (NTLP) will be supported to roll out provision of IPT, in line with the WHO recommendations.

In addition, UVRI will work with USG partners such as HEALTHQual, Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. UVRI will collaborate with other key stakeholders at all levels for provision of required wrap around services.

The program will be aligned to the National Strategic Plan for HIV/AIDS and National TB Strategic Plan (2011/12-2014/15), support and strengthen the national M&E systems and work within district health plans. UVRI will work under the guidance of MoH/ACP, NTLP and the Quality Assurance Department in trainings, TB/HIV mentorship and supportive supervision.

UVRI is funded to support SI Pivot to increase use of data for evidence based planning and decision making at all levels in all program areas. UVRI will develop and implement a robust, sustainable and functional information system that focuses on monitoring risk behavior among MARPS, active follow-up, and referrals for services. As an ongoing activity, process monitoring will be integrated into routine programme management functions, and undertaken by project staff. The project staff will be tracking outputs and processes at each level of the prevention package and, ensure data quality, quality of reports and timely dissemination. The overall project progress will be shared with CDC, MOH/ACP, UAC through quarterly, semi-annual and annual reports. UVRI will ensure that project plans, activities and M&E are consistent with the three ones principle.

UVRI project has been promoting HIV risk avoidance or risk reduction practices as an important component of HIV prevention activities for most-at-risk populations, and measuring change in this area is central to the task of monitoring and evaluating these activities. Tracking changes in sexual behavior overtime gives an indication of the success or effectiveness of a package of activities aimed at promoting safer behavior and reducing the spread of HIV in most-at-risk populations.

When assessing the effectiveness of HIV interventions, UVRI will use prospective cohort data collected as part of a routine program, with intensive follow-up and efforts to ascertain outcomes in sexual behavior, and effective referrals. This activity will provide evidence to inform policy and will also provide the project staff with an opportunity to analyze and interpret relevant individual and aggregate data for ongoing program evaluation, strategic review and information to inform scale up and policy formation. The enhanced prevention program, as well as, M&E systems will result in better efficiency and quality of services and better targeting and outreach to those in need. This will increase the number of people living with HIV who are in care and treatment, increase the number of people who have tested for HIV, and increase the coverage for PMTCT services and those accessing male circumcision. In addition, through the building of a combination prevention package at multiple levels and the evaluation of such a package, the resulting PEPFAR prevention portfolio will benefit from understanding the role of high risk groups in the project and will contribute to the Emergency Plans goal of preventing 12 million infections.

The UVRI Enhanced Prevention Program will contribute to the overall (HIV Testing and Counseling (HTC) goals for PEPFAR by increasing access to and use of essential counseling and testing services for Female Sex Workers (FSW) and their clients and regular partners.

The program will scale-up Provider Initiated Testing and Counseling (PITC) using innovative approaches including; community outreaches and a peer-led model. Demand for HCT will be increased through community mobilization and peer education. Female sex workers will also be counseled on importance and benefits of couple counseling and encouraged to refer their partners for HCT. Other innovative approaches for their male sexual partners to receive HTC will be explored. The program will contribute to the continuum of response by counseling male clients on benefits of Voluntary Medical Male Circumcision (VMMC) and linking them to VMMC providing centers. Peer educators will escort male clients willing to have VMMC to VMMC providing centers. HIV positive individuals identified from HTC will be enrolled into pre-ART care and screened for ART eligibility, and those found to be eligible will be initiated on ART.

This program will be implemented in Kampala. The target coverage is 7,773. The program will be implemented in collaboration and partnership with; MoH/ACP, other PEPFAR partners, community bar owners, centers offering VMMC and GBV support, and other existing initiatives targeting sex workers.

The program will work in partnership with the Medical Access Uganda Limited to ensure a steady supply of HIV rapid test kits for HTC services to be delivered efficiently.

In order to maximize program success, this program will work towards gathering evidence for the purpose of standardizing service delivery using World Health Organization HTC Quality Assurance/Quality improvement guidelines.

UVRI will enroll Female Sex Workers (FSW) in Kampala and deliver a wide range of high impact sexual prevention interventions to them and their male partners. These interventions include: risk reduction counseling to reduce risk of HIV transmission; condom promotion and distribution, screening and management for STI, family planning and antenatal care, counseling and referral for male circumcision and screening for alcohol. Risk reduction counseling will be offered to both HIV positive and HIV negative clients individually and/or in small groups. BCC interventions for FSW and their clients will be used to support risk reduction.

Condom and lubricant use will be promoted through improved self-efficacy interventions, including building skill for condom negotiation and use. These interventions will be evidence-based and tailored to barriers and opportunities for behavior change identified through ongoing and earlier research efforts with the target populations. These interventions will focus on promoting use of both female and male condoms.

Structural interventions to reduce vulnerability to HIV will also be considered, particularly approaches such as sustainable/alternative livelihood interventions, as well as gender issues, recognizing that gender norms are contributing factors driving the HIV epidemic in Uganda, particularly among FSW and other MARPS. The interventions will involve gender sensitive approaches and will be designed to address underlying gender dynamics and norms that increase vulnerability to HIV infection. The program will provide prevention and response to Gender Based Violence (GBV) services and will aim to strengthen care for survivors of sexual violence (SV). Within health care facilities, providers will screen for GBV and offer health services to survivors; strengthen referrals from the health facility to other support services; and strengthen linkages between clinical services and other stakeholder groups to facilitate access to health services.

A component of economic empowerment will also be integrated in partnership with livelihood promotion organizations

UVRI will work with community members and other community initiatives including; MARP-friendly sites in Kampala, community bar owners, and expert peer educators, to increase demand for and utilization of services. Continuum of response will be strengthened using linkage facilitators across different service points; from the community to the clinic and from the clinic to other facilities.

UVRI will initially concentrate on scaling-up the above interventions within the Good Health for Women Project, while systematically generating evidence through collecting data, analyzing and synthesizing for scale-up of interventions within existing health facilities in wider Kampala.

UVRI will work in collaboration with CDC-Uganda and other PEPFAR partners, and will be under the guidance of MoH/ACP and the Ministry of Gender, Labor and Social development strategy. The program will be aligned to with the National frameworks, PEPFAR II guidance as well as Global Health Initiatives principles that focus on a women and a girl-centered approach.

UVRI will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. UVRI will enroll at least 549 new adult clients on treatment and support 631 adults and children on current ART by APR 2013, contributing to overall national and PEPFAR target of 190,804 new clients and 490,028 individuals currently on treatment. This target is not a ceiling, allowing for higher achievements with continued program efficiencies. Priority will be given to enrolment of HIV positive pregnant women, TB/HIV patients, and key populations. The main focus of UVRIs program is working with and supporting Commercial Sex Workers.

UVRI will support the MoH roll out of Option B+ for eMTCT through the following activities; training and mentorship and joint PMTCT/ART support supervision. UVRI will also support ART/PMTCT integration with same day integrated in the clinic.

Continuum of Response linkages and referrals will be strengthened using linkage facilitators across different service points from the communities to the facility. Expert peers will be used as linkage facilitators for TB/HIV integration to ensure early ART initiation for TB/HIV patients. UVRI will support reproductive health integration including family planning and cervical cancer screening at the facility level through provision of the services or referrals.

UVRI will implement quality improvement initiatives for the ART framework: early initiation of ART, eligible clients on treatment; improve adherence and retention and monitor treatment outcomes. Use of innovative, low cost approaches for adherence, retention and follow up such as: phone/SMS reminders, appointment registers, alert stickers will be utilized. Special emphasis will be placed on adherence and retention of women enrolled under Option B+.

UVRI will focus will be placed on increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. UVRI will support the sample referral network in line with this national CD4 expansion plan; and will monitor and report clients access to CD4 in quarterly reports.

UVRI will liaise with PACE and UHMG for provision of family planning commodities to clients. ARV drugs and other HIV commodities will be provided by Medical Access Uganda Limited.

The program will be aligned to the National Strategic Plan for HIV/AID (2011/12-2014/15), to support and strengthen the national M&E systems. UVRI will work under the guidance of MoH/ACP and the Quality Assurance Department for trainings, ART/PMTCT mentorship and support supervision.