Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013 2014 2015

Details for Mechanism ID: 9301
Country/Region: Uganda
Year: 2013
Main Partner: John Snow, Inc
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $6,095,690

The overall goal of the STAR-EC program is to increase access to, coverage of, and utilization of quality comprehensive HIV&AIDS and TB prevention, care and treatment services within district health facilities and their respective communities. The key objectives are: (1) Strengthening decentralized HIV&AIDS and TB service delivery systems with emphasis on health centers (HCs) IV and III and community outreaches (2) Improving quality and efficiency of HIV&AIDS and TB service delivery (3) Strengthening networks and referrals systems, and (4) Intensifying demand for HIV&AIDS and TB prevention, care and treatment services. STAR-EC supports nine districts including, Bugiri, Iganga, Kaliro, Kamuli, Mayuge, Namutumba, Buyende, Namayingo and Luuka. Key populations are targeted including commercial sex workers, fisher-folk, migrant workers, MSMs, motorcyclists and long distance truck drivers as well as the general population. FY13 activities include: promotion of ABC, SMC, PMTCT and PEP, HTC, care and support, pediatric and adult antiretroviral therapy, TB/HIV co-management and laboratory support. The focus is consolidation of support for delivery of quality services and improving access for the key populations and those in underserved, hard-to-reach area guided by HIV epidemiological data. In partnership with the districts and the civil society organizations, STAR-EC will focus on capacity building, integration of supported activities, quality improvement, strengthening of laboratory services, capacity building in pharmaceutical management, and strengthening of coordination structures and partnerships to facilitate transition at the end of program life. M&E will be accomplished using the performance management plan and the Lot Quality Assurance Sampling surveys.

Funding for Care: Adult Care and Support (HBHC): $258,370

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. STAR-EC will support the provision of care services to 40,012 HIV positive adults as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals receiving a minimum of one clinical care service. This is a subset of the overall care target. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations such as truck drivers, fishermen, commercial sex workers and MSMs. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. STAR-EC will be expected to implement approaches to promote an effective CoR model and monitor key indicators along the continuum.

STAR-EC will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthen positive health dignity and prevention (PHDP); strengthen linkages and referrals using linkage facilitators; implement quality improvement for adherence and retention; pain and symptom management; and provide support to targeted community outreaches 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. Working with the Central Public Health Laboratory and other stakeholders, CD4 coverage will be improved from 60% currently to 100% over the next 12 months. STAR-EC 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.

STAR-EC will build the capacity of facility staff in pharmaceutical management including quantification and accurate and timely ordering and reporting, and liaise with National Medical Stores (NMS), Joint Medical Store (JMS), and SCMS to ensure adequate supplies of HIV commodities for all sites.

In addition, STAR-EC will work with USG partners such as PIN, SPRING, HEALTH Qual, SIS, and Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services; and they will collaborate with other key stakeholders at all levels for provision of required wrap around services including family planning, etc..

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

STAR-EC will ensure gender issues and awareness are integrated in programs to ensure equitable access to care and treatment services such as identifying and addressing barriers that women and men may face in adhering to treatment or receiving ongoing care.

Funding for Care: Orphans and Vulnerable Children (HKID): $288,479

STAR-EC is strategically planning to implement know your childs HIV status campaign with the purpose of early identification of HIV positive children and link them for care and treatment support. In order to minimize loss to follow up and to improve retention and adherence to care and treatment, the program plans to build and maintain formalized linkages and referral systems between its facilities and community programs. The SUNRISE project conducted a service providers mapping and updated an inventory of OVC service providers to facilitate referrals. STAR-EC plans to ensure that a linkage facilitator is placed at all child clinics, avail them with the OVC provider inventory, and empower them to identify children in need of social support. The linkage facilitator will then coordinate with the social services programs in the community to offer comprehensive services and complete the continuum of response. STAR-EC will coordinate with OVC partners to mobilize OVC households for health outreached organized by the facilities. Children identified at the community in need of health services will be referred to STAR-EC supported facilities and a system to easily identify them and walk them through the facility for clinical support will be strengthened. For the growing population of children on ART transitioning into adolescence and adulthood will be linked to community peer support groups, mentorship programs and to adolescent reproductive and family health services. The facility linkage facilitators will be trained to assess the needs of the identified child and refer them accordingly. For example, children sexually abused, after clinical support will be linked to programs like SUNRISE to follow up on the legal issue and community psychosocial support.

Funding for Care: TB/HIV (HVTB): $328,406

STAR-EC 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. STAR-EC will contribute to this target by screening 39,572 HIV positive clients for TB, and initiate 1,319 HIV positive clients in care on TB treatment. This target was derived using burden tables based on district HIV prevalence and treatment need. The Continuum of Response (CoR) model will be applied to ensure improved referrals and linkages.

STAR-EC will improve intensified case finding (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. STAR-EC will support MDR-TB surveillance through sputum sample transportation to Gene Xpert hubs and receipt of results at facilities.

In FY13, STAR-EC will ensure early initiation of all HIV positive TB patients on ART through the use of linkage facilitators and/or the provision of ART in TB clinics. STAR-EC will increase focus on adherence and completion of TB treatment, including DOTS through use of proven cost effective approaches. A TB infection control focal person will be supported to enforce infection control at facilities using interventions such as: cough hygiene, cough sheds, fast tracking triage by cough monitors, and ensuring adequate natural ventilation.

The MOH/ACP and NTLP will be supported to roll out provision of IPT, in line with the WHO recommendations.

In addition, STAR-EC will work with USG partners such as PIN, SPRING, HEALTH Qual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. STAR-EC will collaborate with other key stakeholders at all levels for provision of required wrap around services.

STAR-EC will build the capacity of facility staff in pharmaceutical management including quantification and accurate and timely ordering and reporting, and liaise with NMS and JMS to ensure adequate supplies of anti-TB drugs and diagnostic supplies for all sites.

The program will be aligned to the National Strategic Plan for HIV/AIDS and National TB Strategic Plan (2011/12 2014/15), STAR EC will support and strengthen the national M&E systems and work within district health plans. STAR-EC will work under the guidance of MoH AIDS Control Program, National TB and Leprosy Program and Quality Assurance Department in trainings, TB/HIV mentorship and support supervision. Additionally, STAR-EC will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

Funding for Care: Pediatric Care and Support (PDCS): $129,399

STAR-EC will focus on supporting the GOU to further expand pediatric HIV care with the goal to achieve universal access to care by 2015. STAR-EC program will target 3,957 children with care and support services, contributing to the overall PEPFAR target of 73,169 HIV positive children receiving at least one clinical care service. This is a subset of the PEPFAR target. This target was derived using burden tables based on district HIV prevalence and treatment need. The CoR model will be applied to ensure improved referrals and linkages.

STAR-EC will provide comprehensive child friendly care and support services in line with national guidelines and PEPFAR guidance; improve adolescent services and strengthen linkages and referrals using linkage facilitators; implement quality improvement for adherence and retention, and; provide support to targeted community outreaches in high prevalence hard to reach and underserved areas. EID services and focal points at facilities will be scaled up to ensure follow up and active search of exposed children in facilities and communities to enable early enrolment of children in care. A priority focus will be on scaling up low cost approaches, such as use of caretaker support groups to support retention in care. STAR-EC will implement community mobilization and targeted activities such as Know your childs status campaigns to identify more children. Focus will be placed on improved assessment of pre-ART children for ART eligibility to ensure timely initiation on treatment in line with MoH guidance.

STAR-EC will support retention of adolescents in care as well as ensure a smooth transition into adult life using expert peers and adolescent support groups. They will be provided with PWP /PHDP services including, sexual and RH services, psychosocial support and life skills training. Lessons learned from the planned national adolescent service assessment will be incorporated in activities.

A key priority will be to establish strong referrals between OVC and care and support programs to ensure HIV positive children are linked to OVC services, and children provided with OVC services are screened for HIV and appropriately linked to care and support. STAR-EC will also support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

STAR-EC will liaise with PACE and UHMG for provision and distribution of basic care kits to clients and work with NMS, JMS and SCMS to ensure adequate, uninterrupted supplies of HIV commodities.

STAR-EC will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, Health Qual, SIS, and Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. STAR-EC will collaborate with UNICEF and 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/AID (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. STAR-EC will work under the guidance of MoH AIDS Control Program and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and support supervision.

Funding for Laboratory Infrastructure (HLAB): $360,700

In FY 2012, STAR-EC will assist the MOH, working in collaboration with the Central Public Health Laboratories (CPHL), to establish two new laboratory hubs at Bugiri hospital and Bumanya HC IV, in Bugiri and Kaliro districts respectively. This is in addition to the ongoing laboratory strengthening at Kamuli hospital which is already a functional laboratory hub. The major focus of STAR-E support in FY13 will be (1) building CD4 capability,(2) strengthening specimen referral and result transmission network, (3) improving laboratory infrastructure, (4) improving facility level quantification and reporting ensure adequate supplies of CD4 and other reagents, and (5) assist the labs to implement the WHO recommended stepwise strengthening laboratory management towards accreditation (SLAMTA) with the aim of achieving a minimum of the three star WHO rating by September 2014. STAR-EC will also work with district officials and relevant stakeholders to recruit five lab technologists and three lab technicians to ensure that all the three hubs have the necessary human resources required to run their laboratories at optimal capacity.

In addition, STAR EC will also work with NMS, JMS and SCMS to ensure that 19 facilities in the region that received PIMA point of care CD4 analyzers in FY2012, and four other facilities with existing CD4 capacity, receive adequate, uninterrupted supplies of the necessary cartridges, reagents and supplies in a timely manner. STAR- EC will work with SUSTAIN and SCMS to ensure that CD4 machines have regular preventive maintenance to reduce equipment down time.

Funding for Strategic Information (HVSI): $175,000

In FY 2013, STAR EC is funded to support SI Pivot 3 Strong/robust basic M&E systems at service delivery points and districts in its nine districts. This activity aims to generate strategic information to inform national policy and decision making and support tracking of program targets, including outcome and impact measurements, and evidence-based programming.

Activities to improve data utilization for planning and decision making will include; data quality assessment exercises to improve the quality of reporting; conducting health facility and household LQAS surveys and dissemination of findings at district, sub district and sub-county levels during which remedial action plans will be drawn; district level performance reviews for local governments and civil society organizations (CSO) in the nine districts so they can track performance against targets and identify solutions to program barriers; bi-annual CSO specific performance reviews during which quarterly CSO work plans will be reviewed; and training of CSOs and district health facility staff in M&E skills to address M&E gaps. By supporting district, health sub-district and sub-county level performance reviews and LQAS disseminations, STAR-EC will contribute to building human resource capacity for effective data utilization at all levels which is a key M&E strategy of the national health sector plan.

Service Provison Assessment and Improvement (SPAI) will also be conducted in selected districts to improve performance. Activities to enhance organizational learning and evidence based programming will include operational research on five priority topics with a focus on (i) MARPs mapping and characterization, ii) Voluntary medical male circumcision among the MARPs, (iii) low couple HTC, (iv) EID, and (v) sustainability of village health teams. STAR-EC will improve on data presentation methods through the use of GIS to illustrate different health service gaps, points as well hotspots of MARPs. These activities support the national health sector evidence-based decision making, national health sector learning and improvement, while feeding information into the national surveillance system which is a key national M&E requirement

STAR-EC will also support the following SI-related activities:

1. procurement and distribution of updated HMIS facility registers and other data collection tools and training of health workers on the revised HMIS tools;

2. rollout of the Electronic Medical Records (EMR) system in all ART sites in their districts by installing and maintaining computers and training of medical records officers on the system;

operationalization of national OVC MIS at the lower levels.

Funding for Biomedical Prevention: Voluntary Medical Male Circumcision (CIRC): $1,506,721

The revised COP2012 strategic pivots for VMMC in the STAR-EC region will focus on increasing coverage in their nine districts that have high HIV prevalence in the general population, high HIV prevalence among women and low circumcision prevalence. VMMC service delivery will be prioritized in areas with a high prevalence and where MARPs are concentrated such as truck stops along the northern transport corridor, fishing villages and landing sites. Interventions will focus on all eligible men (including adolescents) in the "catch up" phase to identify persons who are sexually active and at higher risk of acquiring HIV. Males aged 30 years and above will be deliberately targeted.

An estimated 42,895 men will be circumcised by the STAR-EC project. VMMC will be offered as part of the STAR-EC comprehensive HIV prevention package which includes: promoting delay of sexual debut; abstinence & reduction in the number of sexual partners and being faithful; providing and promoting correct and consistent use of male condoms; providing HTC services; treatment of sexually transmitted infections and referring HIV+ men to appropriate care and treatment services. STAR-EC will integrate VMMC services as part of the continuum of response (COR), contributing to increased access to reproductive health care for men; increased engagement of men in care; and advocacy & better health seeking behaviors of their female partners for HTC, ANC, and eMTCT.

To attain their target, STAR-EC will use multiple approaches to scale up VMMC: stand-alone sites with dedicated teams, integrated VMMC services within 20 health facilities, outreaches and camps. STAR-EC will use the Model for Optimizing the Volume for Efficiency (MOVE) to optimize efficiency and increase the volume safely in all VMMC service outlets. A total of 120 service providers will be trained through programs run by Rakai Health Center, Walter Reed Project and IDI/IHK (public-private partnership). Quality improvement and assurance will be integrated as part of the minimum package of VMMC services through the implementation of national and international quality standards and external quality assurance (EQA). A portion of the VMMC budget has been allocated for safe waste disposal of the disposable male circumcision kits and supplemental instruments and supplies. Providers will be trained to use the non-surgical VMMC device (PrePex) in STAR-EC supported sites when approved by MOH.

To create acceptance and demand for VMMC, community campaigns will be implemented using a mix of approaches: (1) peer-to-peer strategy for interpersonal communication; (2) use of linkage facilitators to mobilize men;( 3) community mobilization; and (4) use appropriate channels of communication including print and electronic mass media. The campaign objectives are to increase knowledge of HIV status among PHLA and their partners, reduction of the risk of HIV transmission and reduction of HIV acquisition among persons at high risk of infection.

STAR-EC will prioritize monitoring and reporting on the VMMC program through the MOH VVMC Operational Centre reporting system and periodic data quality assessments.

Funding for Testing: HIV Testing and Counseling (HVCT): $571,000

In order to support the overall PEPFAR HTC goals, STAR-EC will continue to employ the Know Your Epidemic, Know Your Response (KYE, KYR) approach to programming for HTC scale-up focusing on promoting knowledge of ones own and partner HIV status in the supported districts.

HTC services will be provided at 140 health facilities with the addition of 33 HCs II to the pre-existing 91 facilities, reaching an estimated 100,000 individuals of which 10,000 are estimated to be most-at-risk. STAR-EC will focus the HTC interventions on key populations in areas of high HIV prevalence, as guided by epidemiological data, and low service coverage using the most efficient contextualized interventions. Target populations for HTC services include, MARPs, couples, pregnant women, HIV exposed children, TB patients and STI clients. These individuals will be reached using several approaches including Provider Initiated Counseling and Testing (PICT), with referral to care and treatment for positive clients, as well as referrals to other health services for all clients; devoted couples testing and counseling weeks; integrated HTC, SMC, ART and TB outreaches to the island communities; moonlight HTC specifically targeting the truckers and the commercial sex workers; home-based HTC specifically targeting couples; and home-based HTC designed to target the partners and exposed children of HIV positive index clients as a means of maximizing the identification and referral to care of all family members diagnosed HIV positive.

STAR-EC will also support training and supervision of health personnel to provide HTC services. These trainings will utilize the five-day National PICT Curriculum in order to standardize information sharing. In particular, the program will support the training of personnel from the newer CSO grantees (including BIWIHI and SIWAO that will specifically be working on the islands) and the NACWOLA community support agents in home-based HTC services using the MoH curriculum. The program will, in collaboration with districts and other partners to ensure appropriate health care waste management standards at the new HTC facilities.

STAR-EC will build the capacity of facility staff in pharmaceutical management including quantification and accurate and timely ordering and reporting, and work with National Medical Stores (NMS), Joint Medical Store (JMS), and SCMS to ensure adequate supplies of HIV test kits and consumables for all sites.

These activities will ensure adherence to and support of QA/QI standards.

STAR-EC will support the district health facilities and the CSOs to maintain quality HTC services through regular support supervisions by joint MoH, STAR-EC and District teams designed to ensure that health workers offer quality HTC services. VHTs, music dance and drama shows and radio stations will be harnessed to mobilize communities for HTC services. The program will support the production and dissemination of MoH data collection tools such as HTC client cards and registers. Health facilities will be supported to transport samples to reference laboratories for quality control. A total of 66 health workers will be trained to provide quality HTC services and 130,000 people are targeted to receive HTC services.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $500,000

In alignment with the key COP12 pivots, STAR-EC activities will address the prevention needs of the primary target groups-- older adults youth out of school, discordant couples, MARPs/key populations -- through the implementation of high impact interventions in high HIV burden districts and hot spots frequented by MARPs.). In 2011, STAR EC undertook a MARPS mapping study and identified commercial sex workers and their clients, long distance truck drivers, motorcyclists, fisher folk as the key population for this region. The Hotspot marking through the PLACE methodology, will map out key populations including MSM in the various regions. This will help STAR -EC tailor interventions to any new identified key populations in this region

To increase demand and utilization of condoms among these key populations, STAR-EC will work with the USG communication partner to develop an advocacy strategy aimed at de-stigmatizing condoms. Community promotional campaigns will be implemented in high burden and hot spot areas through peer-to-peer strategy for interpersonal communication; use of linkage facilitators to mobilize men; community mobilization; and use appropriate channels of communication including print and electronic mass media. STAR-EC will increase the number of strategically located condom distribution outlets and engage with social marketing partners and the local hospitality industry to make condoms readily available particularly in bars, lodges and hotels in hot spots.

Amongst the MARPS, the interventions will focus on increasing perception of HIV risk associated with sex work, strengthening PwP among infected MARPs at facility and community levels, and scale up of evidence-based behavioral interventions like ART adherence, condom use. they will provide age-appropriate and comprehensive risk reduction strategies for young people who access their sites. Such programs will include reduction in the number of sexual partners ; providing and promoting correct and consistent use of male condoms. STAR-EC will target all clients in care and treatment with PHDP interventions with the aim of increasing knowledge of HIV status among PHLA and their partners, reducing the risk of HIV transmission and reducing HIV acquisition among person at high risk for infection. A total of 3,500 PLHA will be reached.

Program monitoring and evaluation activities will be supported within this budget to strengthen the collection of data through national HMIS tools and to improve the technical quality of data through periodic data quality assessments. Data use at facility level will be strengthened.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,000,000

STAR EC will use $ 1M PMTCT acceleration plan funds from FY 2011. Using PMTCT acceleration funds, STAR-EC FY13 plans are to consolidate quality eMTCT service provision at 85 existing sites; increase access to eMTCT services through an additional 43 health facilities in high HIV prevalence areas (islands and lake shore facilities); capacity building and mentorships to improve eMTCT service delivery; and improving access to family planning, treatment of sexually transmitted infections and sexual and gender based violence services. STAR-EC will support provision of eMTCT services (as per 2010 WHO guidelines-Option B+) in 128 public and private not for profit (PNFP) health units across their nine districts using the four- prong approach. The target population includes pregnant women and their spouses, HIV positive pregnant women, HIV exposed infants, and health workers providing eMTCT services. HIV positive pregnant women will receive prophylactic ARV regimens (Option A) or treatment (Option B+) as appropriate. Eight hundred health workers will be trained in eMTCT according to the new national eMTCT guidelines. Provider initiated counseling and testing services will be promoted in maternal, neonatal and child health clinics, maternity and postnatal wards. STAR-EC will focus on creating demand for family planning services at both facility and community levels, and strengthening of the integration of family planning in HIV care services. The program will continue to promote HIV repeat testing for pregnant women during the third trimester, labour and delivery; safer delivery practices with particular emphasis to the island HCs II, the provision of anti-retroviral drugs for reduction of MTCT and the counseling on safe infant feeding practices. Six of the nine districts will receive funds from SDS to physically transport blood samples to the three referral laboratories in the region for CD4 testing. The other three districts will be facilitated through the Strengthening of Decentralization System (SDS) project. PMTCT mothers will be provided with cotrimoxazole prophylaxis and TB screening and management. Eligible clients (i.e.CD4 count of <350) will be counseled and enrolled into the HIV clinics to initiate Highly Active Anti-retroviral Therapy (HAART). To further improve access of the HIV exposed babies to EID, STAR-EC will support both the national EID and Child Day drive in April and October; and the quarterly Know your Childs Status drive in the nine districts. In FY13, HIV counseling and testing services will be provided to 102,706 pregnant and lactating women. An estimated 5,228 HIV+ pregnant women will be identified, of which 4,443 will be initiated on HAART for life and 784 will be provided with ARV prophylaxis. Infant EID and ARV prophylaxis will be provided to 5,228 exposed babies.

STAR-EC will continue to support the entire 85 mentor mothers based at 42 health facilities to provide one-on-one and group support. Family support group meetings (FSGs) will be facilitated at all eMTCT facilities to enhance adherence support to clients (mother-baby pairs) on ART and those that need to be followed up through the eMTCT cascade will also be facilitated. Lay providers, including the mentor mothers, CSAs, VHTs and the health workers, will be facilitated to actively follow up the mother-baby pairs missing clinic appointments particularly those that cannot be traced using telephone.

Funding for Treatment: Adult Treatment (HTXS): $966,110

STAR-EC will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. STAR-EC will enroll at least 9,506 new clients and support 20,515 adults on 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.

STAR-EC will support the MoH roll-out of Option B+ for eMTCT through accreditation of health facilities as per the MoH accreditation scale-up plan and training, mentorship and joint PMTCT/ART support supervision. STAR-EC will support ART/PMTCT integration at facility level, piloting feasible service delivery models such as same- day integrated HIV clinics. CoR linkages and referrals will be strengthened using linkage facilitators across different service points in facilities and communities and include TB/HIV integration to ensure early ART initiation for TB/HIV patients. Targeted community outreaches in high prevalence hard to reach and underserved areas will be conducted. STAR-EC will also target key populations using innovative approaches including setting up specialized services, such as moonlight services.

STAR-EC will implement quality improvement initiatives for the ART framework including: early initiation of ART eligible clients on treatment, improving adherence and retention and monitoring of treatment outcomes. Support will be given to use of innovative, low cost approaches for adherence, retention and follow up such as phone/SMS reminders, appointment registers, and alert stickers. Special focus will be placed on adherence and retention of women enrolled under Option B+ and increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. STAR-EC will support the sample referral network in line with the national CD4 expansion plan and will monitor and report clients access to CD4 in quarterly reports.

STAR-EC will build the capacity of facility staff in pharmaceutical management including quantification and accurate and timely ordering and reporting, liaise with UHMG for provision and distribution of basic care kits to clients and work with NMS, JMS and SCMS to ensure adequate, uninterrupted supplies of HIV commodities.

In addition, STAR-EC will work with USG partners and stakeholders for provision of required wrap around services, particularly family planning and malaria diagnosis and treatment. STAR-EC will work under the guidance of MoH ACP and Quality Assurance Department in trainings, ART/PMTCT mentorship and support supervision. Funding has been provided through Strengthening Decentralization for Sustainability (SDS) program to support the recruitment of additional staff in STAR-EC supported districts to achieve program targets. STAR-EC will ensure gender awareness and issues are integrated in programs to ensure equitable access to care and treatment services such as identifying and addressing barriers that women and men face in adhering to treatment or receiving ongoing care.

Funding for Treatment: Pediatric Treatment (PDTX): $11,505

STAR-EC will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. STAR-EC will enroll at least 1,806 new HIV positive children on treatment and support 3,066 children current on ART by APR 2013. This will contribute to the overall national and PEPFAR target of 39,799 new pediatric enrolments and a total of 64,072 children currently on treatment.

In FY13, STAR-EC will support the national program scale up of pediatric treatment through strengthening the identification, follow up and treatment for all infants through EID focal persons, peer mothers, SMS messages/phone calls and flagging files with initiate ART immediately stickers. Facilities will be supported to strengthen test and treat for all HIV positive children under two years of age in line with the national treatment guidelines.

STAR-EC will support the early initiation, adherence and retention of adolescents on treatment using expert peers and adolescent support groups. They will be provided with PWP /PHDP services including: sexual and reproductive health services, psychosocial support and life skills training.

A key priority will be to establish strong referrals between OVC and care and support programs to ensure children on treatment are linked to OVC services, and children provided with OVC services are screened for HIV and appropriately linked to treatment. STAR-EC will support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

STAR-EC will liaise with PACE and UHMG for provision and distribution of basic care kits to clients and work with NMS, JMS and SCMS to ensure adequate, uninterrupted supplies of HIV commodities. STAR-EC will build the capacity of facility staff in pharmaceutical management including quantification and accurate and timely ordering and reporting.

In addition, STAR-EC will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTH Qual, ASSIST, and Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. STAR-EC will collaborate with UNICEF and 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/AID (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. STAR-EC will work under the guidance of MoH/ AIDS Control Program and Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework and support supervision.

Subpartners Total: $0
AIDS Information Center: NA
Communication for Development Foundation - Uganda: NA
Family Life Education Program: NA
Friends of Christ Revival Ministries: NA
Integrated Development Activities and AIDS Concern: NA
Mothers2Mothers: NA
National Community of Women Living with HIV/AIDS: NA
Uganda Cares: NA
Uganda Reproductive Health Bureau: NA
World Education: NA
Youth Alive Zambia: NA
Cross Cutting Budget Categories and Known Amounts Total: $517,268
Gender: Gender Based Violence (GBV) $30,000
Human Resources for Health $427,268
Key Populations: FSW $60,000
Key Issues Identified in Mechanism
Implement activities to change harmful gender norms & promote positive gender norms
Mobile Populations
Safe Motherhood
Tuberculosis
Family Planning