Project Title: Uganda Fiscal Year 2007 Country Operational Plan (COP)
|Field Programs Funding by Account||Central Programs Funding by Account|
|Notified as of March 2007||Notified as of June 2007||Notified as of November 2006|
|Implementing Agency||GAP||GHAI||Subtotal: Field Programs Funding||GAP||GHAI||New Subtotal: Field Programs Funding||GHAI Central Programs||Total Dollars Allocated: Field & Central Funding|
HIV/AIDS Epidemic in Uganda:
Estimated Population: 28,816,000*
HIV Prevalence rate: 6.7%*
# of HIV infected: 1,000,000*
Estimated # of OVCs: 1,000,000*�
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
Prevalence is in adults only (15-49 years)
�Orphans aged 0-17 due to AIDS
Targets to Achieve 2-7-10 Goals:
Total # Individuals Receiving Care and Support
Total # Individuals Receiving ART
End of Fiscal Year 2004*
End of Fiscal Year 2005**
End of Fiscal Year 2006***
End of Fiscal Year 2007****
End of Fiscal Year 2008****
*Results. �Engendering Bold Leadership: The President�s Emergency Plan for AIDS Relief.� First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, March 2005
**Results. �Action Today, a Foundation for Tomorrow: The President�s Emergency Plan for AIDS Relief.� Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February, 2006
***Results. �Power of Partnerships: The President�s Emergency Plan for AIDS Relief.� Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February, 2007
****FY 2007 Country Operational Plan targets
The results of the recently released Uganda HIV Sero Behavioral Survey (UHSBS) revealed an adult HIV prevalence of 6.4%. Approximately 940,000 Ugandans are HIV positive, of which approximately 100,000 are children under the age of 18. Women, urban dwellers, and those living in the conflict regions are the most severely affected. Forty percent of those who are HIV positive have an HIV negative spouse. HIV incidence in Uganda�s mature epidemic is showing signs of stagnating, which means that the number of new infections is no longer decreasing. More than one million people have died, and there are an estimated one million orphans as a direct result of HIV/AIDS. Families and communities are no longer able to absorb and meet the needs of those who are HIV-positive, and millions of children are vulnerable, orphaned, or otherwise affected by the epidemic. As a result, women, orphans, and other vulnerable groups are particularly susceptible to property-grabbing, sexual exploitation, violence, abuse, and a life of absolute poverty.
All of the 940,000 Ugandans who are HIV positive require access to comprehensive care and support services. In light of a severely burdened public health system, the USG is supporting faith-based networks, civil society, and the private sector to complement the public sector and play a key role in ensuring the delivery of services and essential commodities. An estimated 150,000 people in Uganda are currently in need of treatment. As of March 2006, Uganda�s Ministry of Health (MOH) estimated that 75,000 Ugandans were receiving antiretroviral treatment (ART). Of these, the USG directly supported ART for 38,712 in 102 service outlets throughout the country. The USG is the largest provider of pediatric AIDS treatment services in the country. Approximately 8,000 pediatric patients, out of an estimated 36,000 in need, receive ART services through USG-supported programs.
As a result of the HIV/AIDS epidemic, Uganda is among the 22 countries in the world with the highest tuberculosis (TB) burden. TB remains the leading cause of morbidity and mortality for people living with HIV/AIDS. In fiscal year 2007, a key goal for the Emergency Plan in Uganda will be to increase the number of HIV positive TB patients receiving palliative care (PC) and ART. Treating these patients is part of the USG�s comprehensive approach in support of national priorities.
Additional Funding: In June 2007, an additional $23,925,571 was allocated to expand the PMTCT portfolio and increased support for OVC and TB/HIV activities, while further strengthening basic care services. Through the technical working group (TWG) process, $1,200,000 of the additional funds were identified to support new medical male circumcision (MC) activities in Uganda.
The Emergency Plan funding will focus on the following programmatic areas to achieve the Plan�s 2-7-10 targets:
Prevention: $43,560,420 ($35,639,124 Field and $7,921,296 Central) (21.1% of prevention, care, and treatment budget)
Data from national surveys and from two longitudinal study sites in Uganda (Masaka and Rakai) indicate that, after a period of declining HIV prevalence and incidence, the downward trend seems to be stabilizing. These findings have been further substantiated by the final analysis of the UHSBS, revealing an HIV prevalence of 6.4 % among the adult population. This rate, combined with the figure released by UNAIDS of 135,000 new infections in the last year, has fueled concern within the Government of Uganda (GOU) that successes to date could be threatened. The predominant mode of HIV transmission in Uganda is sexual, and the key driver is higher risk sex, defined as multiple concurrent partners, HIV discordance (one partner is HIV positive while the other is HIV negative), and unprotected sex. Prevention priorities, identified in response to the transmission modes, include behavior change for risk reduction and risk avoidance, counseling and testing, supportive disclosure of HIV status, prevention of mother to child transmission (PMTCT), post exposure prophylaxis, and condoms. Emergency Plan activities in fiscal year 2007 are aligned with the Ugandan national �Road Map for Accelerated HIV Prevention,� as well as USG global guidance, most notably in emphasizing the prevention of sexual transmission of HIV as a key priority area.
In fiscal year 2007, USG supported prevention programming will consolidate and strengthen its existing abstinence programs for young people through a combination of in-school and out-of-school programs, media, and community approaches. Programming will continue to support the Ministry of Education and Sports, to reach students in primary schools with information about HIV and life skills so that they may avoid risky situations and remain abstinent from sex; to strengthen and enhance teachers� skills to interact effectively with children; to create safe school environments; and to promote outreach activities from the school into the surrounding community. The USG will continue to support President Museveni�s Presidential Initiative for AIDS Strategy for Communication to Youth (PIASCY). Additionally, messages targeting men will be incorporated into Emergency Plan activities.
Currently, the USG provides both direct and indirect support for PMTCT services, and plans to continue that support in fiscal year 2007 with routine opt-out counseling and testing (CT) for pregnant women. The USG also will continue working with the MOH to revise all training materials to reflect the revised national PMTCT policy; involve men in PMTCT through the family-centered model for HIV care; and strengthen integration of PMTCT into care and treatment programs and treatment referrals for eligible HIV positive mothers and their HIV positive babies.
Efforts to reduce new infections among high-risk or high-transmitter groups (such as HIV discordant couples; members of the uniformed services; mobile populations; and migrant workers) will be expanded and will target locales where high risk activities take place. The USG will target individuals through national behavior change communication, mass media prevention programs, supportive disclosure counseling, condom distribution, and social marketing. In fiscal year 2007, the link between alcohol consumption and HIV transmission will be a focus in selected activities. Support to Northern Uganda will remain a particular focus in fiscal year 2007, with activities targeting Internally Displaced Persons (IDPs) and members of Uganda�s People�s Defense Force. Additionally, positive prevention interventions, which include partner testing and supportive disclosure, STI diagnosis, treatment and prevention, PMTCT, and linkages to family planning, will be integrated into ongoing care and treatment activities by all USG partner organizations, as well as with national associations of People Living with HIV/AIDS (PLWHA).
Finally, in fiscal year 2007, the USG will continue to support the Blood Safety program to consolidate achievements of the past years and bridge gaps in service delivery. Key areas of the program include retention of low-risk, voluntary, non-remunerated repeat blood donors; referral of HIV positive donors to care services; blood collection, testing, storage, and distribution; staff training; quality assurance; infection control; and monitoring and evaluation.
Principal Partners: AIDS Information Center, CARE International, AIDSRelief Consortium/Catholic Relief Services, International Rescue Committee, International Youth Foundation, Inter-Religious Council of Uganda, Johns Hopkins University, John Snow International, Ministry of Education and Sports, Ministry of Gender, Labor and Social Development, Ministry of Health, PATH, Protecting Families Against AIDS, The AIDS Support Organization, Samaritan�s Purse, Uganda Blood Transfusion Services, World Vision International, Family Health International, Population Services International, Mildmay Center International, Baylor University/Pediatric Infectious Disease Clinic, Research Triangle Institute, Young Empowered and Healthy (YEAH), Makerere University Faculty of Medicine, and Ugandan People�s Defense Force (UPDF).
Care: $70,674,459 ($66,934,015 Field and $3,740,444 Central) (34.2% of prevention, care and treatment budget)
Care activities in Uganda include counseling and testing (CT), basic palliative care (PC), support for integrated tuberculosis (TB) care and treatment, and assistance to orphans and vulnerable children (OVC).
Findings from the 2002 Demographic Health Survey reported that 70% of the general population wanted to know their HIV status, but only 10% had access to CT services. To address this, the Ministry of Health (MOH) is emphasizing a national �know your status� message. In support of this effort, USG programs will continue to follow the updated national counseling and testing policy and guidelines, to increase utilization of CT services using a variety of models. In fiscal year 2007, traditional facility-based Voluntary Counseling and Testing (VCT) services will include mobile and community services in several districts. Routine Counseling and Testing (RCT) will continue in regional referral hospitals, selected district hospitals, and Level IV Health Centers, with expanded home-based services to enhance partner and family testing. Finally, door-to-door CT will be continued in selected high prevalence districts. A major focus of all approaches will be to expand opportunities for access to CT, thereby increasing opportunities for partner testing in order to identify HIV discordant couples and provide family testing. CT services also will be further strengthened in health and education programs through additional support for partners to expand geographical coverage and community outreach activities, as well as through private sector initiatives to offer CT services in the workplace.
In fiscal year 2007, the USG will continue to support the implementation of the national TB/ HIV integration policy and communication strategy, through the consolidated and coordinated training of health care providers. Care and treatment implementing partners will be supported with technical assistance, to develop comprehensive TB/HIV activities and TB service, including HIV CT services that are provided either on-site or through effective referral mechanisms. Support for decentralized delivery of HIV/TB services also will be strengthened. The role of PLWHAs will be strengthened, as well, to facilitate referral and adherence and to improve linkages from CT to TB screening. These services will continue in the conflict affected districts.
Approximately 940,000 people in Uganda are living with HIV/AIDS, and all of them require basic palliative health care services and support, whether they are on ART or not. USG support includes a broad range of services that address the continuum of illness, ranging from management of opportunistic infections, psychosocial support, home based care, nutrition, basic preventive care, TB management, pain and symptom control, and spiritual care, to culturally appropriate end-of-life care. The USG will continue to utilize various community based structures for delivery of care and referral at the community level, and will provide access to the basic preventive health package -- which includes two long-lasting insecticide treated mosquito nets, a water safety vessel and chlorine solution, condoms as appropriate, and prevention for positives educational materials. These commodities also will be available through social marketing programs, to accommodate those who can afford to purchase the services.
Currently, Uganda has an estimated two million OVC (14% of all children), representing a more than two-fold increase since 1990. Results from the 2005 UHSBS report indicate that approximately 100,000 children are HIV positive; secondary analysis indicates that approximately 36,000 of these children require antiretroviral (ARV) treatment. Approximately 46% have been orphaned by HIV/AIDS; the remainder have lost their parents primarily through the armed conflict. Of the four million children living in conflict areas, one million are living in internally displaced persons (IDP) camps. The USG, in close partnership with the GOU, will work in the following strategic areas: technical support to the Ministry of Gender, Labor and Social Development; expansion of local government and civil society�s response for service delivery and capacity building of national, district and community organizations; and strengthening networks and linkages between pediatric care and treatment programs and community based OVC services.
Principal Partners: Africare, African Medical and Research Foundation, AIDS Information Center, AIDSRelief Consortium/Catholic Relief Services, ACDI/VOCA, AVSI, Baylor University/Pediatric Infectious Disease Clinic, CARE, Christian AID, Hospice Uganda Africa, Integrated Community Based Initiatives, International Rescue Committee, Johns Hopkins University, Kumi District Director of Health Services, Makerere University Faculty of Medicine, Makerere University Institute of Public Health, Ministry of Health, Mildmay Center International, National Medical Stores, Research Triangle Institute, Opportunity International, Plan Uganda, Population Services International, Salvation Army, and The AIDS Support Organization.
Treatment $92,136,018 ($85,871,343 Field and $6,264,675 Central) (44.6% of prevention, care and treatment budget)
Treatment activities in Uganda include the provision of ARV drugs and service programs, as well as laboratory support.
Results from a secondary analysis of the UHSBS report indicate that, in 2006, approximately 940,000 Ugandans are HIV positive; of these, 170,000 adults and 36,000 children require ARV treatment. In fiscal year 2007, USG support will continue to provide Ugandans with ART in service outlets throughout Uganda. To address this ever-increasing need, the USG will continue to provide comprehensive treatment using its existing networks of partners. The USG will support ART services in public, private, and NGO sector outlets, placing high priority on providing services to those who are most in need. In fiscal year 2007, there will be an emphasis on integrating prevention into treatment programs and providing comprehensive treatment programs in the highest prevalence areas in central and northern Uganda.
The network model continues to foster referrals among partners, which enables HIV positive clients to access a full spectrum of services, including supplemental nutritional support, training in income-generation, and family planning services. Additionally, family and community programs will be strengthened to support this network of comprehensive care for clients and their families. Where these programs have not been initiated, collaborative partnerships will be developed to link HIV positives� partners and family members to integrated prevention, care, and treatment services. Finally, in fiscal year 2007 the USG will continue its work in pediatric AIDS treatment.
For laboratory support, the USG will consolidate current initiatives and increase support for institutional strengthening of the central public health laboratory, as well as regional and district laboratory facilities. The USG also will continue to support both pre-service and in-service training programs for laboratory technicians, and expand initiatives to improve national quality assurance oversight. Additional laboratory data collection and reporting will be supported to improve the provision of services. National programs, such as the rapid HIV test training roll-out, will include laboratory techniques for patient monitoring and treatment.
Finally, fiscal year 2007 funding will continue to support the established Ugandan procurement structures and increase local institutions� capacity with technical assistance in forecasting, distribution logistics, and warehousing of commodities.
Principal partners: African Medical Research Foundation, AIDSRelief/Catholic Relief Services, Baylor University/Pediatric Infectious Disease Clinic, Central Public Laboratory Emerging Markets, Inter-Religious Council of Uganda, Makarere University Institute of Public Health, Joint Clinical Research Center, Makerere University Faculty of Medicine, Mildmay Center International, Ministry of Health, The AIDS Support Organization, Uganda Viral Research Institute, and University Research Corporation.
Other Costs: $30,255,518
The PEPFAR/Uganda Strategic Information (SI) strategy is comprehensive and supports a variety of activities, including routine data collection at district and national levels. A central component of the Emergency Plan�s work in routine data collection involves building the capacity of national and local government, civil society, and faith-based organizations to develop and implement effective monitoring and evaluation systems.
Support for Uganda�s HIV/AIDS antenatal care (ANC) sentinel surveillance activities includes both technical and material support of ANC clinics across Uganda, including those in the war-torn North, where large populations of displaced persons are served. Specific activities which have been undertaken in this area include protocol development, training of site staff, data and specimen collection, supervision, and testing and analysis.
The USG has worked closely with the GOU to implement sentinel surveillance of sexually transmitted diseases among people living with HIV/AIDS, and has begun to support the MOH in conducting HIV surveys among its most-at-risk populations, specifically people in prostitution, members of fishing communities, and other mobile populations.
Principal Partners: John Snow International, Social and Scientific Systems, New York AIDS Institute, Ministry of Health, Macro International, Makerere University Institute of Public Health, Medical Research Council, The AIDS Support Organization, and the University of California San Francisco.
The USG is collaborating with the Ministry of Health, WHO, and other donors on a national human capacity assessment project focusing on health workers. Findings will inform decisions regarding priorities for the use of USG resources for training and system strengthening.
Principal Partners: Ministry of Health, Uganda AIDS Commission, Ministry of Defense, JHPIEGO.
Funds for management and staffing will support the in-country personnel needed for USAID, Department of Health and Human Services, State Department, Department of Defense, and the Peace Corps. Funds will support program monitoring and accountability, and will ensure USG policy and technical leadership within Uganda�s national response; they also will cover compensation, logistics, and office and administrative costs.
Other Donors, Global Fund Activities, Coordination Mechanisms:
The USG continues to engage actively in coordinating, planning, and monitoring HIV/AIDS activities through both Government of Uganda and Development Partner coordination groups. The Uganda AIDS Commission (UAC) is the overall coordinating body for HIV/AIDS in Uganda, and it meets monthly with the national Partnership Committee, which consists of public and private representatives. In addition, the UAC acts as the Secretariat for the Emergency Plan Advisory Committee, which is chaired by the former Prime Minister and is comprised of 19 national representatives from public and private sectors, faith based organizations, and people living with AIDS. The UAC also leads a national HIV prevention working group and a national monitoring and evaluation committee in which the USG participates.
The USG plays an active leadership role in the well-established donor coordination groups for the health (including the national HIV/AIDS program) and education sectors. The MOH implements a �sector wide approach� and hosts monthly Health Policy Advisory Committee meetings, in which all groups working in the public health sector participate.
Long-term institutional arrangements for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) are being established to improve its performance. In addition, other national management systems are being streamlined. The UAC will assume a stewardship role for HIV/AIDS funds to civil society, and will oversee the management of a grants mechanism being managed by a private agency. In addition, the USG is leading an effort to expand an existing grants mechanism, to accommodate funds from the Global Fund and other donors. The MOH will have a lead role in managing public sector funds and will coordinate this through the existing sector structures, including the involvement of USG and other development partners. This will enable the USG to ensure that the Emergency Plan and other HIV/AIDS activities complement one another.
In fiscal year 2007, the GOU will launch a new national social health insurance scheme. The USG will work closely with development partners, the private sector, and the GOU to ensure that the program will be informed with solid data and consultation.
Program Contact: Emergency Plan Coordinator, Premila Bartlett
Time Frame: Fiscal year 2007 � fiscal year 2008
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