Strengthening TB and HIV&AIDS Responses in East Central...

Annual Report, October 2009 | �

Strengthening TB and HIV&AIDS Responses in East Central Uganda (STAR-EC)

Program Year 1 Annual ReportOctober 2009

THE REPUBLIC OF UGANDA

STRENG

THE

NIN

GTB

AN

D

HIV& AIDS RESPONSES IN

EAST

CE

NT

RA

LU

GA

NDA

� | Annual Report, October 2009

© 2009

F�nanc�al support for th�s program �s prov�ded by USAID, under Co-operat�ve Agreement number 6�7-A-00-09-00007-00. The v�ews expressed �n th�s document do not necessar�ly reflect those of USAID.

Th�s program �s �mplemented by JSI Research & Tra�n�ng Inst�tute Inc., �n collaborat�on w�th World Educat�on’s Bantwana In�t�at�ve, Commun�cat�on for Development Foundat�on Uganda, mothers2mothers, and Uganda Cares.

Annual Report, October 2009 | ��

Table Of Contents

L�st of Tables….......................................……………………………………………………………..……. ....... ��

L�st of F�gures………………….......................................………………………………………………………. ��

L�st of Acronyms …………….......................................………………………………………………………… �v

Execut�ve Summary….................................………………………………………………………….......…...... v�

�.0 Introduct�on…………….......................................…………………………………………….....………... �

�.� Background…………….......................................……………………………………….....……………… �

�.2 Major object�ves of STAR-EC...............................…………………………………….....………………… �

2.0 STAR-EC Program Year � Results…………….......................................………...………………………… 2

2.� HIV Counsel�ng and Test�ng …………….......................................………...…………………………..... 2

2.2 Prevent�on of Mother to Ch�ld Transm�ss�on of HIV …………….......................................………...…... 3

2.3 Promot�on of HIV prevent�on through Abst�nence and Be�ng fa�thful...............................………...…… 4

2.4 Promot�on of HIV prevent�on through ‘Other Prevent�on’ methods...............................………...…….. 7

2.5 Male Med�cal C�rcumc�s�on (MMC):...............................………...…………................................…….. 8

2.6 Pall�at�ve Care –Bas�c Health Care for PLHIV...............................………...…………............................. 8

2.7 Pall�at�ve Care – HIV/TB.............................………...………….............................................................. 9

2.8 Ant�retrov�ral Therapy (ART).............................………...…………........................................................ �0

2.9 Pol�cy Analys�s and Systems Strengthen�ng.............................………...………….................................. �0

3.0 Strateg�c Informat�on, Mon�tor�ng and Evaluat�on .............................………...………….............. �2

4.0 Grants and Sub-awards.............................………...…………........................................................ �3

5.0 Conclus�on.............................………...………….......................................................................... �3

Append�x.............................………...………….......................................................................................... �4

�� | Annual Report, October 2009

List of Tables Table �: STAR-EC targets vs. ach�evements by techn�cal area – end of Sept 2009.........................................................v��

Table 2: Behav�oral Change Programs (BCPs) conducted dur�ng the year.......................................................................5

Table 3: Number of �nd�v�duals who rece�ved Other Prevent�on messages....................................................................7

Table 4: Number of HIV pos�t�ve �nd�v�duals who rece�ved pall�at�ve care serv�ces.......................................................8

Table 5: STAR-EC grantee support, May – September 2009..........................................................................................�3

List of FiguresF�gure �: Number of �nd�v�duals who were counseled, tested and rece�ved the�r HIV results �n supported d�str�cts........2

F�gure 2: Number of �nd�v�duals reached w�th AB messages �n supported d�str�cts.........................................................4

Annual Report, October 2009 | �v

List of Acronyms

AB abst�nence and be�ng fa�thful

AIDS acqu�red �mmunodefic�ency syndrome

ART/ARV Ant�retrov�ral Therapy / Ant�retrov�ral

BCC behav�or change commun�cat�on

BCP behav�or change commun�cat�on programs

CDC Centers for D�sease Control and Prevent�on

CD4 Cluster of D�fferent�at�on 4

CDFU Commun�cat�on for Development Foundat�on Uganda

CHAI Cl�nton Foundat�on HIV&AIDS In�t�at�ve

CSA commun�ty support agent

CSO c�v�l soc�ety organ�zat�on

DAC D�str�ct HIV&AIDS Comm�ttee

EGPAF El�zabeth Glaser Ped�atr�c AIDS Foundat�on

FLEP Fam�ly L�fe Educat�on Program

HBC home-based care

HC health center

HCP Health Commun�cat�on Partnersh�p

HCT HIV counsel�ng and test�ng

HIV human �mmunodefic�ency v�rus

HMIS health management �nformat�on systems

IEC �nformat�on, educat�on and commun�cat�on

JCRC Jo�nt Cl�n�cal Research Centre

JMS Jo�nt Med�cal Store

JSI JSI Research & Tra�n�ng Inst�tute, Inc.

LQAS Lot Qual�ty Assurance Sampl�ng

m2m mothers2mothers

MARPs most-at-r�sk populat�ons

MDD mus�c, dance and drama

MMC male med�cal c�rcumc�s�on

MoH M�n�stry of Health

NACWOLA Nat�onal Commun�ty of Women L�v�ng w�th HIV&AIDS

NMS nat�onal med�cal stores

OVC orphans and other vulnerable ch�ldren

OP Other prevent�on

PEPFAR Pres�dent’s Emergency Plan for AIDS Rel�ef

v | Annual Report, October 2009

PLACE Pr�or�t�es for Local AIDS Control Efforts

PLHIV persons l�v�ng w�th HIV

PMTCT prevent�on of mother-to-ch�ld transm�ss�on of HIV

PY� Program Year �

PY2 Program Year 2

PACE Programme for Access�ble Health Commun�cat�on and Educat�on

RCT rout�ne counsel�ng and test�ng

RTI Research Tr�angle Inst�tute Internat�onal

SCMS Supply Cha�n Management System

SOP standard operat�ng procedure

STAR Strengthen�ng TB and HIV&AIDS Responses (at d�str�ct level)

STAR-E Strengthen�ng TB and HIV&AIDS Responses �n Eastern Uganda

STAR-EC Strengthen�ng Tuberculos�s and HIV&AIDS Responses �n East Central Uganda

STI sexually transm�tted �nfect�on

TB tuberculos�s

TB CAP Tuberculos�s Control Ass�stance Program

TB-CBDOTS Tuberculos�s Commun�ty-Based D�rectly Observed Therapy Short-course

TOT tra�n�ng of tra�ners

UAC Uganda AIDS Comm�ss�on

UNITY Uganda In�t�at�ve for TDMS and PIASCY

URHB Uganda Reproduct�ve Health Bureau

USAID Un�ted States Agency for Internat�onal Development

USG Un�ted States Government

UVRI Uganda V�rus Research Inst�tute

VHT v�llage health team

WHO World Health Organ�zat�on

YA Youth Al�ve

Annual Report, October 2009 | v�

Th�s report h�ghl�ghts Strengthen�ng Tuberculos�s and HIV&AIDS Responses �n East Central Uganda (STAR-EC Program) Year � act�v�t�es that were �mplemented over s�x months from March – September 2009. In accordance w�th Cooperat�ve Agreement No. 6�7-A-00-09-00007-00, th�s report �s be�ng subm�tted to

USAID by JSI Research & Tra�n�ng Inst�tute, Inc. the lead partner �n the �mplementat�on of the STAR-EC program.

Dur�ng PY�, STAR-EC �mplemented start up act�v�t�es as well as fac�l�ty and commun�ty-based act�v�t�es through the four pre-qual�fied CSOs and a number of publ�c health fac�l�t�es. The program began �n March 2009 w�th the �n�t�al step of �dent�fy�ng office space �n J�nja. It was also dur�ng th�s per�od that add�t�onal key program staff was recru�ted. STAR-EC �n�t�ated program act�v�t�es by conduct�ng v�s�ts to the 6 d�str�cts of Bug�r�, Iganga, Kal�ro, Kamul�, Mayuge and Namutumba to expla�n the program object�ves and strateg�es and to map out strateg�es for �nvolvement of the d�str�ct leadersh�p and lower-cadre d�str�ct staff. The d�str�cts were further �nv�ted to a workshop where they were fac�l�tated to come up w�th pr�or�ty act�v�t�es and �mplementat�on strateg�es that were to be supported by STAR-EC. These meet�ngs (w�th d�str�cts) were also attended by the four pre-qual�fied CSOs namely Fam�ly L�fe Educat�on Program (FLEP), Nat�onal Commun�ty of Women L�v�ng w�th HIV&AIDS �n Uganda (NACWOLA), Uganda Reproduct�ve Health Bureau (URHB) and Youth Al�ve Uganda (YAU). Both d�str�ct and CSO expectat�ons were leveled and the need for �mplement�ng act�v�t�es �n a synerg�st�c manner was underscored at these forums. In add�t�on, the startup per�od was character�zed by extens�ve d�scuss�ons between STAR-EC and the M�n�str�es of Health and Local Government counterparts and the�r TB and HIV&AIDS coord�nat�on structures. USAID-funded projects and other stakeholders �mplement�ng act�v�t�es �n the East Central reg�on were also �nvolved �n these d�alogues. In part�cular, a number of meet�ngs were held between the s�ster STAR-E and STAR-EC projects �n wh�ch future exchange of data, �nformat�on, and exper�ence were d�scussed �n great deta�l. As a result of these meet�ngs, STAR-EC expects harmon�zat�on of approaches, collaborat�on �n �mplementat�on of act�v�t�es such as tra�n�ng, and leverag�ng d�fferent structures put �n place by other programs.

Dur�ng th�s report�ng per�od, STAR-EC �mplemented most act�v�t�es through the 4 pre-qual�fied CSOs and �0 health fac�l�t�es. To fac�l�tate �mplementat�on, a total of USh 52�,328,058 was approved and d�sbursed to the CSOs.

Deta�ls of ach�evements over PY� relat�ve to targets have been prov�ded �n Table � �n th�s sect�on. Although the targets were not real�zed �n some areas, �t suffices to note that these results were ach�eved through pragmat�c approaches �nclud�ng s�gn�ng memoranda of understand�ng w�th partners and speedy prov�s�on of grants to the 4 CSOs. It should also be noted that results were part�cularly atta�ned dur�ng the last quarter of the program year.

CSOs ma�nly �mplemented commun�ty based act�v�t�es (CBAs) such as abst�nence and be�ng fa�thful (AB) and other/ prevent�on act�v�t�es. Only two CSOs, FLEP and URHB, �mplemented HCT act�v�t�es through 37 serv�ce outlets �nclud�ng commun�ty outreaches. STAR-EC prov�ded techn�cal ass�stance to �0 health centers (4 hosp�tals and 6 HC IVs) �n prov�s�on of qual�ty pall�at�ve care serv�ces. Only URHB prov�ded pall�at�ve care HIV/TB serv�ces w�th STAR-EC support. STAR-EC was supported by the Tuberculos�s Control Ass�stance Program (TBCAP) to prov�de techn�cal ass�stance to the s�x partner d�str�cts �n develop�ng annual TB work plans for PY2.

Related to ant�retrov�ral therapy (ART) serv�ce prov�s�on, STAR-EC, through the Supply Cha�n Management Systems (SCMS) project, suppl�ed the hosp�tals of Iganga and Kamul� M�ss�on w�th four months stock of ARV med�c�nes meant for ex�st�ng pr�or ART cl�ents plus 400 new ones. In add�t�on, staff at four hosp�tals (Kamul� M�ss�on, Iganga, Kamul� and Bug�r� D�str�ct Hosp�tals) rece�ved on the job mentorsh�p �n ARV log�st�cs management. These fac�l�t�es were also prov�ded w�th postage/fax fees to ensure t�mely report�ng d�rectly to Nat�onal Med�cal Stores (NMS). STAR-EC tra�ned �9 health workers from the four hosp�tals on comprehens�ve HIV&AIDS treatment �nclud�ng ART. A total of 456 cl�ents were prov�ded w�th ART dur�ng the year �nclud�ng 6� (4� females, 20 males) new (na�ve) cl�ents. However, only 372 cl�ents could be d�saggregated by sex or age.

Laboratory support was extended to ten fac�l�t�es through a memorandum of understand�ng s�gned between

Executive Summary

v�� | Annual Report, October 2009

STAR-EC and JCRC. Through th�s arrangement 3�8 CD4 tests were conducted at the Jo�nt Cl�n�cal Research Centre (JCRC) laboratory located at Kak�ra Reg�onal Centre of Excellence hosp�tal, J�nja.

No actual �mplementat�on of PMTCT act�v�t�es took place �n the reg�on dur�ng PY� as STAR-EC was engaged �n handover d�scuss�ons and jo�nt v�s�ts w�th El�zabeth Glaser Ped�atr�c AIDS Foundat�on (EGPAF) so as to ensure a smooth trans�t�on of act�v�t�es by the end of September 2009. Further d�scuss�ons were held w�th Research Tr�angle Inst�tute (RTI) w�th the �ntent�on of streaml�n�ng PMTCT serv�ces �n fac�l�t�es where RTI �s �mplement�ng rout�ne counsel�ng and test�ng (RCT) �n the reg�on.

In relat�on to strateg�c �nformat�on, a total of 66 personnel (54 from the s�x local governments and �2 from CSOs) were tra�ned �n the ent�re appl�cat�on of the Lot Qual�ty Assurance Sampl�ng (LQAS) methodology �nclud�ng data collect�on, tabulat�on, analys�s, program mon�tor�ng, report wr�t�ng and �nterpretat�on of results. Th�rty n�ne personnel from four CSOs were also supported and g�ven techn�cal ass�stance �n data qual�ty management. Add�t�onally, 350 CSO personnel were tra�ned �n systems strengthen�ng (�05 on �nst�tut�onal capac�ty bu�ld�ng and 245 on HIV commun�ty mob�l�zat�on, prevent�on, care, treatment and HIV-related st�gma reduct�on). The 245 tra�ned personnel �ncluded 200 NACWOLA Commun�ty Support Agents and 45 URHB peer educators. As part of the STAR-EC health fac�l�ty basel�ne survey, assessments on d�str�ct health systems were conducted �nclud�ng assessments on the current funct�onal�ty of HMIS, Health Un�t Management Comm�ttees, and support superv�s�on from MoH and d�str�cts to lower health fac�l�ty levels.

March-Sept.2009 (PY1) End of Project (EOP)

Intervention area

IndicatorAnnual Target-

PY1Achieved

% Achieved

Comments on PY1

achievements

Overall Target

Cumm. Achieve-

ment

% Achieved

1. HIV Counseling and Testing

Number of �nd�v�duals who rece�ved counsel�ng and test�ng for HIV/TB and rece�ved the�r test results

25,000 �0,376 42

Was l�m�ted by the number of �mplement�ng partners

400,000 �0,376 3

Number of �nd�v�duals tra�ned �n HIV counsel�ng and test�ng

- 64 - 400 64 �6

2.Abstinence and Faithfulness

Number of �nd�v�duals reached through commun�ty outreach programs that promote HIV and AIDS prevent�on through abst�nence and/or be�ng fa�thful

25,000 39,737 �59

Ut�l�zed a mult�-pronged approach that �nvolved d�fferent groups �nclud�ng model couples, rel�g�ous leaders, peer educator etc

283,000 39,737

Table 1: STAR-EC targets vs. achievements by technical area – end of September 2009

Annual Report, October 2009 | v��


Intervention area


PY1Achieved

% Achieved

Comments on PY1

achievements

Overall Target

Cumm. Achieve-

ment

% Achieved

2.Abstinence and Faithfulness

Number of �nd�v�duals reached through commun�ty outreach programs that promote HIV and AIDS prevent�on through abst�nence only

- �,737 -

USAID changed strategy to hav�ng the UNITY program �mplement ‘A’ only �ntervent�ons

- �,737 -

Number of �nd�v�duals tra�ned to prov�de AB serv�ces

- 234 - �,265 234 �8

3. Other HIV Prevention activities

Number of �nd�v�duals reached through commun�ty outreach program that promote HIV prevent�on through other behav�or change beyond abst�nence and/or be�ng fa�thful

- �2,�79 -No target set for PY�

50,000 �2,�79 24

Number of condom serv�ce outlets

�22 236 �93 400 236 59

Number of serv�ce prov�ders tra�ned �n-OP

- 230 -No target set for FY�

830 230 28

4. a) Palliative Care Basic

Number of �nd�v�duals prov�ded w�th pall�at�ve care/bas�c health care and support (HBHC) for HIV �nfected �nd�v�duals (�nclud�ng TB/HIV)

4,000 283 8No target set for PY�

- 283 -

�x | Annual Report, October 2009


Intervention area


PY1Achieved

% Achieved

Comments on PY1

achievements

Overall Target

Cumm. Achieve-

ment

% Achieved

4. b) Palliative Care TB/HIV

Number of �nd�v�duals tra�ned to prov�de HIV and TB related pall�at�ve care

- 64 -No target set for PY�

700 64 9

Number of HIV /TB co-�nfected cl�ents who rece�ved care/treatment

200 4 2 4,900 4 0

Number of TB pos�t�ve cl�ents who rece�ved HCT and test results

300 �3 4 5,500 �3 0

5. Strategic Information

Number of �nd�v�duals tra�ned on strateg�c �nformat�on related area-M&E, d�sease surve�llance and HMIS

54 66 �22 �50 66 44

6. Institutional & Individual Capacity Building

Number of �nd�v�duals tra�ned �n other/pol�cy analys�s and system strengthen�ng


- 347 -

Number of �nd�v�duals tra�ned �n pol�cy development

- - -No target set for PY�

- - -

Number of �nd�v�duals tra�ned �n �nst�tut�onal capac�ty bu�ld�ng

- �02 -No target set for PY�

- �02 -

Number of �nd�v�duals tra�ned �n st�gma & d�scr�m�nat�on reduct�on

- - -No target set for PY�

- - -

Number of �nd�v�duals tra�ned �n commun�ty mob�l�zat�on


- 245 -

Annual Report, October 2009 | x


Intervention area


PY1Achieved

% Achieved

Comments on PY1

achievements

Overall Target

Cumm. Achieve-

ment

% Achieved

7. HIV Treatment/ARV Services

Number of adults and ch�ldren w�th advanced HIV �nfect�on newly enrolled on ART

400 6� �5Under-ach�eved by 85%

8,000 6� �

Number of naïve adults and ch�ldren w�th advanced HIV �nfect�on who ever started on ART


7,200 372 5

Number of �nd�v�duals tra�ned �n PMTCT

- �9 -No target set for FY�

400 �9 5

Current number of adults and ch�ldren w�th advanced HIV �nfect�on rece�v�ng ant�retrov�ral therapy (ART)


8,600 372 4

Source: STAR-EC program records, 2009

� | Annual Report, October 2009

1.0 Introduction

1.1 Background

STAR-EC �s a five-year d�str�ct-based �n�t�at�ve a�med at �ncreas�ng access to, coverage of, and ut�l�zat�on of qual�ty comprehens�ve HIV&AIDS and TB prevent�on, care, and treatment serv�ces w�th�n d�str�ct health fac�l�t�es and the�r respect�ve commun�t�es �n s�x d�str�cts of East Central Uganda. STAR-EC �s �mplemented

by a consort�um of five partners that �nclude: JSI Research & Tra�n�ng Inst�tute Inc., (JSI) as the pr�me partner; World Educat�on’s Bantwana In�t�at�ve; Commun�cat�on for Development Foundat�on Uganda (CDFU); mothers2mothers (m2m); and Uganda Cares – all as sub-partners respons�ble for var�ous techn�cal aspects of the program.

STAR-EC also has four pre-qual�fied grantees as local �mplement�ng partners: The Fam�ly L�fe Educat�on Program (FLEP), the Nat�onal Commun�ty of Women L�v�ng w�th HIV&AIDS �n Uganda (NACWOLA), the Uganda Reproduct�ve Health Bureau (URHB), and Youth Al�ve (YA). Add�t�onally ten c�v�l soc�ety organ�zat�on grantees w�ll be �dent�fied dur�ng PY2 through a compet�t�ve grant�ng mechan�sm and prov�ded w�th support to �mplement some of the �ntervent�ons that form part of STAR-EC’s scope of work.

Currently, the s�x d�str�cts covered by STAR-EC �nclude Bug�r�, Iganga, Kal�ro, Kamul�, Mayuge and Namutumba. If cab�net recommendat�ons are approved by the Parl�ament of Uganda, �t �s expected that dur�ng PY2 three add�t�onal new d�str�cts of Buyende (carved out of Kamul�), Luuka (carved out of Iganga), and Namay�ngo (carved out of Bug�r�) may become operat�onal �n the program’s geograph�cal area of coverage.

The East Central region has some unique characteristics that include:

• A h�gh fert�l�ty rate of approx�mately 7.51

• H�gh HIV prevalence of 6.5%2, wh�ch coupled w�th a h�gh populat�on �n the reg�on results �n a s�gn�ficantly

h�gher number of adults est�mated to be l�v�ng w�th HIV&AIDS �n the reg�on (~74,000 �n 2009)

• H�gh level of mult�ple concurrent sexual relat�onsh�ps3 �nclud�ng polygamy

• H�gh level of transact�onal sexual act�v�ty at some truck stops on the Northern Transport Corr�dor

• S�gn�ficant populat�on of m�grant labor (work�ng �n ma�nly the sugar cane plantat�ons and �n r�ce scheme) and fisher-folk – commun�t�es that can be character�zed as be�ng at h�gh r�sk of contract�ng HIV

1.2 MajorobjectivesofSTAR-ECSTAR-EC has five major objectives that include:

�. Increas�ng access to, coverage of, and ut�l�zat�on of qual�ty comprehens�ve HIV&AIDS and TB prevent�on, care, and treatment serv�ces w�th�n d�str�ct health fac�l�t�es and the�r respect�ve commun�t�es;

2. Strengthen�ng decentral�zed HIV&AIDS and TB serv�ce del�very systems w�th emphas�s on health centers (HCs) IV and III and commun�ty outreach;

3. Improv�ng qual�ty and effic�ency of HIV&AIDS and TB serv�ce del�very w�th�n health fac�l�t�es and commun�ty serv�ce organ�zat�ons;

4. Strengthen�ng networks and referral systems to �mprove access to, coverage of, and ut�l�zat�on of HIV&AIDS and TB serv�ces; and

5. Intens�fy�ng demand generat�on act�v�t�es for HIV&AIDS and TB prevent�on, care, and treatment serv�ces.

� Uganda Bureau of Stat�st�cs (UBOS)and Macro Internat�onal Inc. 2007. Uganda Demograph�c and Health Survey, 2006. Calverton, Maryland , USA: UBOS and Macro Internat�onal Inc.2 M�n�stry of Health (MOH)[Uganda] and ORC Marco. 2006.Uganda HI/AIDS Sero-behav�oral Survey 2004-2005.Calverton, Maryland, USA: M�n�stry of Health and ORC Macro3 UAC (2007) Mov�ng Towards Un�versal Access: Nat�onal HIV&AIDS Strateg�c Plan 2007/8- 20��/�2.. Uganda AIDS Comm�ss�on, Republ�c of Uganda

Annual Report, October 2009 | 2

2.1HIVCounselingandTesting

In Program Year� (PY�), STAR-EC supported two pre-qual�fied CSOs (Uganda Reproduct�ve Health Bureau and Fam�ly L�fe Educat�on Program) to �mplement HIV counsel�ng and test�ng (HCT) act�v�t�es w�th

emphas�s be�ng placed on most-at-r�sk and hard-to-reach populat�ons. A total of 64 �nd�v�duals were tra�ned to offer HCT serv�ces. HCT was offered through numerous approaches that �ncluded stat�c serv�ces, outreaches, home-based HCT, and ‘commun�ty camp�ng’. Hard-to-reach populat�ons were prov�ded HCT serv�ces through commun�ty-based approaches such as home-based HCT. FLEP ma�nly ut�l�zed a recent �nnovat�on, ‘commun�ty camp�ng’, to ensure a w�der commun�ty reach by enabl�ng counselors to

meet commun�ty members at anyt�me they returned to the�r homes. In th�s approach, serv�ce prov�ders stay for over five days �n a g�ven commun�ty

offer�ng HCT serv�ces dur�ng t�mes conven�ent to res�dents.

In some of the commun�t�es where HCT was conducted us�ng the commun�ty camp�ng approach, an average of 40% of el�g�ble �nd�v�duals were tested and rece�ved there results. Us�ng these comb�ned approaches to serv�ce del�very, ��,�84 cl�ents were counseled w�th 93% of them be�ng tested. Of the �0,42� cl�ents who were tested, �0,376 (4,552 male & 5,824 female) �nd�v�duals rece�ved the�r HCT results. HCT was prov�ded through 37 serv�ce outlets �nclud�ng commun�ty outreaches �n Kamul�, Kal�ro, Namutumba, Mayuge and Bug�r� d�str�cts. All the 372 HIV-pos�t�ve cl�ents (�30 male & 242 female) were referred to the relevant health fac�l�t�es for ongo�ng care and support. Home-based HIV counsel�ng and test�ng was a major area of �ntervent�on �n extend�ng HCT to couples and the�r fam�ly members.

Figure 1:

Number of individuals who were counseled, Tested and received their HIV results in supported districts

CSO staff conducting a rapid test during an HBHCT visit

12,000

10,000

8,000

6,000

4,000

2,000

Bugiri

Kaliro

Kamuli

May

uge

Namutum

baTo

tal

Males

Females

Total

Total HIV Postive

2,643

259 192153345

26

1,892

2,817

4,709

55866

1,331

2,197

288 194482

4,552

372

5,824

10,376

626

1,329

1,314


2.0 STAR-EC Program Year 1 Results

3 | Annual Report, October 2009

• D�str�cts where home to home HCT and commun�ty camp�ng approaches were ut�l�zed produced the h�ghest number of served �nd�v�duals

• Overall, 89% of �nd�v�duals rece�ved HCT serv�ces from commun�ty outreaches

• An HIV prevalence of 3.6% was reported from all those who tested and rece�ved the�r results

• HCT �ntervent�ons were not �mplemented �n Iganga D�str�ct as there were no CSOs to �mplement these �ntervent�ons dur�ng the report�ng year

Lessons Learned

• The commun�ty camp�ng approach was an effect�ve way of reach�ng more cl�ents espec�ally the MARPS and other hard-to-reach populat�ons

• Better results were rece�ved from ta�lored commun�ty �ntervent�ons such as conduct�ng HCT outreachnear places often frequented by commerc�al sex workers and the�r partners

• Involvement of stakeholders �nclud�ng local counc�l and rel�g�ous leaders �n plann�ng and �mplementat�on of act�v�t�es was �mportant �n ensur�ng success

• Prov�s�on of HIV counsel�ng and test�ng serv�ces �n homes served as a good strategy for reach�ng out to couples, espec�ally males, who otherw�se would not have turned up at commun�ty outreach s�tes or health fac�l�t�es

• Collaborat�on between the four pre-qual�fied CSOs y�elded synerg�es where commun�ty support agents (CSAs) compl�mented HCT dur�ng outreaches by prov�d�ng educat�on on HIV&AIDS, TB, HIV/TB and other care and support serv�ces needed by commun�ty members

Challenges and the Way Forward• Hav�ng on board only two CSOs w�th capac�ty to prov�de HCT serv�ces �n commun�t�es led to fewer

�nd�v�duals than targeted be�ng Tested. The program plans to �nvolve more CSOs through a compet�t�ve grants mechan�sm �n PY2

• CSOs that d�d not offer comprehens�ve HCT and the subsequent complementary care and support serv�ces, such as Cotr�moxazole for cl�ents d�agnosed w�th the HIV, had to refer these cl�ents to other health fac�l�t�es Many cl�ents d�d not attend the�r referral appo�ntments

• Stock out of HCT test k�ts and other related commod�t�es �n the country was a challenge s�nce the program had no buffer at the t�me. Add�t�onally, there was lack of access to these commod�t�es by CSOs d�rectly from the Nat�oanl Med�cal Stores (NMS). Among other plans, STAR-EC w�ll create buffer stocks for HIV test k�ts dur�ng the rest of program l�fe and work on �mprov�ng coord�nat�on w�th NMS so as to avo�d s�m�lar occurrences �n the future

Dur�ng the start-up per�od, STAR-EC prov�ded the CSOs w�th HIV k�ts and other consumables �nclud�ng �7,A000 Determ�ne, �,320 Stat-pak, and 200 Un�gold. In add�t�on, CSOs rece�ved vaccuta�ner tubes, needles, needle holders, cap�llary tubes, p�pettes, lancets, b�ohazard gloves, cotton wool, cetr�m�de, and d�sposable gloves.

2.2PreventionofMother-to-ChildTransmissionofHIVDur�ng PY�, STAR-EC held d�scuss�ons and conducted jo�nt v�s�ts w�th EGPAF who were w�nd�ng up the�r PMTCT supported act�v�t�es �n the d�str�cts of Namutumba, Iganga and Mayuge. These d�scu ss�ons enabled STAR-EC to learn of approaches that were adopted by EGPAF that �ncreased the ut�l�zat�on of PMTCT serv�ces �n the three aforement�oned d�str�cts. Add�t�onally, these d�scuss�ons ensured a smooth trans�t�on and hand over of PMTCT s�tes to the STAR-EC program.

Furthermore, STAR-EC part�c�pated �n a key meet�ng that was organ�zed by the CDC and RTI w�th the �ntent�on of streaml�n�ng the co-ex�stence of partners that support rout�ne counsel�ng and test�ng (RCT) and PMTCT act�v�t�es w�th�n the Eastern Reg�on. As a way forward, RTI was requested to work out a mode of ex�t�ng the respect�ve PMTCT s�tes where they co-ex�st w�th other USG funded partners. Dur�ng th�s report�ng per�od, STAR-EC v�s�ted fac�l�t�es �n the s�x d�str�cts and mapped out 35 fac�l�t�es where PMTCT serv�ces w�ll be prov�ded �n PY2.


2.3PromotionofHIVPreventionthroughAbstinenceandBeingFaithfulDur�ng PY�, STAR-EC �mplemented abst�nence and be fa�thful (AB) act�v�t�es through two CSOs namely, the Uganda Reproduct�ve Health Bureau (URHB) and Youth Al�ve. A total of 234 �nd�v�duals, �nclud�ng model couples, peer educators, and rel�g�ous leaders were tra�ned to promote AB messages through �nd�v�dual and/or small group behav�or change commun�cat�on channels. These �nd�v�duals �mplemented grassroots peer-led act�v�t�es such as �mpart�ng l�fe sk�lls to out-of-school youth and persons �n marr�age and cohab�t�ng relat�onsh�ps to adopt HIV r�sk reduct�on behav�ors �nclud�ng delay�ng sexual debuts, secondary abst�nence, couple fa�thfulness, and partner reduct�on.

The above ment�oned CSOs reached �,737 out-of school youth w�th abst�nence-only messages and altogether 39,737 �nd�v�duals were reached w�th abst�nence and or be fa�thful (AB) messages through �nd�v�dual and/or small group level d�scuss�ons conducted from �29 serv�ce outlets (see F�gure 2). Th�s ach�evement was real�zed through conduct�ng commun�ty drama shows, mus�c, dance and drama (MDD) fest�vals for out-of-school youth, couple d�alogue sess�ons, peer educat�on sess�ons, and fidel�ty sem�nars. Dur�ng the STAR-EC start-up program, year, however, there were no CSOs �mplement�ng AB �ntervent�ons �n Mayuge D�str�ct.

Figure 2: Number of individuals reached with AB messages in different districts

Messages on mutual fidel�ty; gender based v�olence reduct�on, and pos�t�ve confl�ct resolut�on �n homes; referrals for couple test�ng, pall�at�ve care, and TB serv�ces; alcohol and substance abuse �n relat�on to HIV&AIDS were del�vered to youth and persons �n marr�age and cohab�t�ng relat�onsh�ps w�th�n commun�t�es through �nd�v�dual peer-led and home-to-home d�alogue sess�ons. In add�t�on, ‘model couples’ d�scussed pos�t�ve parent�ng and sp�r�tual counsell�ng

STAR-EC partners used the ‘Value for L�fe’ tra�n�ng program to tra�n abst�nence and be fa�thful promoters. Th�rteen behav�or change commun�cat�on programs (BCPs) were conducted for out-of-school youth dur�ng the year �n Iganga, Namutumba, Kal�ro, and Kamul� d�str�cts as �nd�cated �n the table below.

Bugiri Iganga Kaliro Kamuli Namutumba Total

45,000

40,000

35,000

30,000

25,000

20,000

15,000

10,000

5,000 4,149

5,158

9,307

1,962

4,456

6,438

3,9565,443

9,399

4,1864,757

8,943

2,7862,864

5,650

17,039

22,698

39,737

Males

Female

Total



Table 2: Behavioral Change Programs (BCPs) conducted during the year

Districts No. of BCPsNo. of �nd�v�duals reached

Males Females TotalIganga 3 �05 �42 247Kal�ro 2 �42 ��5 257Kamul� 4 288 �59 447Namutumba 4 250 �35 385Total 785 551 1,336


The youth were equ�pped w�th knowledge and sk�lls to enable them understand the causes of HIV&AIDS; assess the�r r�sks; set goals as well as plans.

Add�t�onally, Youth Al�ve organ�zed a reg�onal MDD fest�val for out-of-school youth w�th a theme “Together Towards an HIV&AIDS Free-Generat�on” �n Kamul� d�str�ct. The fest�val attracted drama groups from Namutumba, Kal�ro, and Iganga d�str�cts. The fest�val was an opportun�ty to talk to commun�ty members and counsel youth on the�r personal problems. The fest�val also gave drama groups from d�fferent d�str�cts an opportun�ty to learn from each other on how to del�ver messages through mus�c dance and drama.

Ten out-of-school-youth clubs were formed and supported w�th var�ous sports and play k�ts for abst�nence promot�on act�v�t�es �nclud�ng peer-led educat�on talks on HIV prevent�on that were typ�cally conducted after sports and games sess�ons w�th�n commun�t�es. STAR-EC procured footballs, netballs, nets, volleyballs, poles and d�fferent board games that were used to set up youth clubs.

Add�t�onally, STAR-EC re-pr�nted �0,000 comm�tment cards (7,000 Engl�sh and 3,000 Lusoga) wh�ch were used by CSOs dur�ng BCPs to promote:

• Awareness on HIV & AIDS and STIs

• Values that empower young people to comm�t to fidel�ty when they get marr�ed

• Empowerment to make �nformed cho�ces �n relat�on to pos�t�ve behav�ors

• L�fe plann�ng sk�lls so as to help them ach�eve the�r dreams and amb�t�ons

In order to qu�ckly have ava�lable relevant IEC mater�als, STAR-EC adapted and repr�nted already approved mater�als and obta�ned others for d�str�but�on from partners l�ke the Health Commun�cat�on Partnersh�p and JCRC.

What works well• Ta�lor�ng var�ous �nformat�on sources to the targeted populat�ons fac�l�tated r�ch d�scuss�ons on AB

messages. Th�s was real�zed w�th a peer to-peer approach where youth peer educators �mplemented act�v�t�es for out-of-school youth and ‘model couples’ �mplemented act�v�t�es for persons �n marr�age and cohab�t�ng relat�onsh�ps

Youth Alive conducting a BCP in Namutumba district

Community drama group performing during a regional festival in Kamuli district


SUCCESS STORY

FromStreetKidtoaSchoolBoy

Yusuf Bag�re �s a �5 year old boy born �n Kasokoso Central Iganga town. H�s father d�ed �n 2006

when Yusuf was only �2 years old. At that t�me, he was a pr�mary five pup�l study�ng at Kasokoso Central Pr�mary School. In a per�od of about three months h�s mother sh�fted to ‘Dodoma’ Island �n Mayuge d�str�ct. Stay�ng w�th h�s grandmother As�fa �n Iganga Central town was the only opt�on left for h�m. In the aftermath of h�s father’s death, Yusuf’s l�vel�hood s�tuat�on deter�orated to the extent of go�ng w�thout food, lament�ng that ‘Enaku edhindi nga titufuna kyakulya’ mean�ng that on some days they would go w�thout meals. He started m�ss�ng classes unt�l he dropped out of school completely.

He was ent�ced to jo�n a group of street k�ds known as the “zebra crew” who are �nvolved �n vend�ng water for surv�val. The crew had a bel�ef that people go to school to get money; “We were sell�ng water to get money, why then go to school? I could smoke c�garettes, mar�juana and had mult�ple sexual relat�onsh�ps. I watched pornograph�c mov�es �n Kasokoso c�nema halls where I could somet�mes spend n�ghts”. When asked how h�s grandmother would react on h�s return, he sa�d ‘Grandmother knew I was an adult’.

In July 2009, Youth Al�ve (YA) w�th support from USAID through STAR-EC, organ�zed a youth tra�n�ng �n Iganga Town Counc�l. Yusuf was among the youth tra�ned and he related how most of the tra�n�ng content m�rrored h�s own l�fe. When

YA talked about hav�ng mult�ple partners as a danger to the l�ves of the youth that can lead to contract�ng sexually transm�tted d�seases �nclud�ng HIV&AIDS, Yusuf looked back at h�s l�fe and thought he was already a v�ct�m. Add�t�onally, the tra�n�ng

emphas�zed educat�on as the only key to success for the youth yet he had dropped out of school. Other bad behav�or that were known to be affect�ng the youth were alcohol�sm, smok�ng of c�garettes and mar�juana, watch�ng pornography and d�srespect�ng parents. YA shared w�th the youth d�fferent l�fe sk�lls that can help them upl�ft the�r morals, attend school, respect others and avo�d hav�ng sexual relat�onsh�ps before marr�age.

Youth were also adv�sed to learn about the�r HIV status by tak�ng HIV&AIDS tests.

G�ven the powerful messages that were d�ssem�nated dur�ng th�s tra�n�ng, Yusuf dec�ded to break away from the ‘Zebra Crew’ group. He says, “Now I stay at home and have resumed school”. He jo�ned pr�mary s�x �n second term but he was �rregular at school because of the cont�nued peer pressure from the ‘Zebra Crew’ members. Dur�ng h�s th�rd school term, Yusuf has started to l�ve a stable l�fe and he says, ‘Teachers, fellow pup�ls and my grandmother love me so much because these days I behave well’. He says he performs very well �n Mathemat�cs and Engl�sh. When asked of h�s future, he sa�d, “Now that am �n school, I plan to become a book wr�ter so I can wr�te about HIV&AIDS among the youth”. When asked whether he also took the HIV test, he reported test�ng negat�ve at Kasokoso Church Cl�n�c. Even then, he plans be re-tested at Iganga D�str�ct Hosp�tal.

• CSOs offer�ng AB promot�onal act�v�t�es have partnered w�th other CSOs who offer other serv�ces such as HCT for compl�mentar�ty so as to enable commun�ty members to benefit from a full package of prevent�on serv�ces

• To effect�vely attract out-of-school youth to HIV prevent�on serv�ces, the program had to use �nnovat�ve approaches that �ncluded recreat�on act�v�t�es such as sports compet�t�ons, mus�c and drama

• Involvement of local counc�l leadersh�p and rel�g�ous leaders y�elded a greater penetrat�on and �mpact �n targeted commun�t�es espec�ally dur�ng commun�ty mob�l�zat�on for AB act�v�t�es g�ven the�r known d�scret�on and confidence �n talk�ng about such sens�t�ve top�cs


Challenges and the Way Forward• USAID changed �ts �mplementat�on strategy to hav�ng only one organ�zat�on, the UNITY program, as the

only �mplementers of the ‘abst�nence only’ �ntervent�ons. Th�s has posed a challenge as many �n-school young people cont�nue to demand these �ntervent�ons

• Sexual and gender-based v�olence (SGBV) �s an �mped�ment to the on-go�ng �ntervent�ons espec�ally for women. In response, model couples have been encouraged to promote am�cable household confl�ct resolut�ons dur�ng home v�s�ts

Dur�ng PY2, STAR-EC w�ll embark on translat�ng IEC mater�als and job a�des from Engl�sh �nto local languages for the local young people to read and eas�ly comprehend. Th�s w�ll also help peer educators and model couples to effect�vely commun�cate to the�r target groups.

2.4 PromotionofHIVPreventionthrough‘OtherPrevention’MethodsSTAR-EC �mplemented other prevent�on methods beyond abst�nence and or be fa�thful pr�mar�ly by target�ng most-at-r�sk populat�ons (MARPs) �n the reg�on. These MARPs �ncluded commerc�al sex workers, long-d�stance truck dr�vers, persons l�v�ng w�th HIV&AIDS, and fisher-folks. Target�ng MARPs was cr�t�cal s�nce they are a major source of h�gher HIV prevalence even w�th�n the general�zed ep�dem�c �n Uganda

1.

Th�s �ntervent�on was �mplemented through CSOs that �ncluded URHB, FLEP and NACWOLA. Through NACWOLA, 200 Commun�ty Support Agents (CSAs) were tra�ned to promote prevent�on among HIV-pos�t�ve persons and the�r partners. Of those tra�ned, 60 were attached to health fac�l�t�es to complement the serv�ces of health workers wh�le �40 CSAs were placed �n commun�t�es. The CSAs based w�th�n commun�t�es conducted home v�s�ts �n wh�ch they del�vered other prevent�on messages and d�str�buted condoms to those �n need. W�th support prov�ded to URHB, 30 part�c�pants were tra�ned as condom d�str�butors. They �ncluded members of fisher folk, park-yard volunteers, barma�ds, and boda boda r�ders. Altogether, STAR-EC tra�ned 230 �nd�v�duals to promote HIV&AIDS prevent�on among MARPs.

To further fac�l�tate prevent�on amongst MARPs, STAR-EC procured and d�str�buted 300 cartons of condoms. Through the efforts of tra�ned prov�ders, a total of �2,�79 MARPs were reached w�th prevent�on messages beyond AB. These messages were rece�ved through 236 outlets �nclud�ng tra�ned commun�ty volunteers, select bars, and lodges. The program also supported the format�on and equ�pp�ng of �0 pos�t�ve-peer support groups. FLEP supported condom educat�on and d�str�but�on amongst MARPS w�th�n ten beaches on the ma�nland and four land�ng s�tes on Jaguz� Island �n Mayuge d�str�ct. URHB supported condom educat�on and d�str�but�on amongst MARPs w�th�n ten beaches on the ma�nland and three land�ng s�tes on Lolwe Island �n Bug�r� d�str�ct.

Table 3: Number of individuals who received other prevention messages

Districts Males Females TotalBug�r� 4,567 �,9�4 6,48�Kamul� �,2�4 300 �,5�4Mayuge 3,279 752 4,03�Namutumba �36 �7 �53Total 9,196 2,983 12,179

1HIV Prevent�on Response and Modes of Transm�ss�on Study, March 2009. Uganda Nat�onal AIDS Comm�ss�on

Peer educator conducts a condom education session to



What is working well• Empower�ng condom d�str�butors through tra�n�ngs that help to �mpart knowledge and sk�lls on commun�ty

condom educat�on and d�str�but�on turned out to be a very good pract�ce. They were able to reach out to commun�ty members w�th the knowledge they had atta�ned from the d�fferent CSOs tra�n�ngs

• Select�ng of condom d�str�butors from d�fferent types of MARPs gave an opportun�ty to reach all the var�ous categor�es of MARPs w�th ‘other prevent�on’ messages

Challenges and the Way Forward• Serv�ce del�very among most-at-r�sk populat�ons was challeng�ng s�nce they d�d not have adequate t�me

to l�sten to the messages preced�ng condom d�str�but�on.

• There �s a h�gh staff turnover among bar ma�ds and attendants who are des�gnated to d�str�bute condoms to revelers, bar customers, and lodgers. Even some bar or lodg�ng propr�etors are not present most of the t�me to help w�th th�s cause

• Messag�ng for other prevent�on was further compl�cated by the lack of �dent�ficat�on, job a�des and IEC mater�als for peer educators

STAR-EC plans to address these challenges �n PY2 ma�nly through promot�on of best pract�ces and �ncreased �nvolvement of var�ous stakeholders, espec�ally MARPs �n the �mplementat�on of these �ntervent�ons.

2.5MaleMedicalCircumcision(MMC)STAR-EC �n�t�ated consultat�ons w�th the Raka� Health Sc�ences Project and Kayunga Hosp�tal regard�ng th�s �ntervent�on. IEC act�v�t�es were commenced so that commun�t�es are educated on the preventat�ve benefits of MMC when used �n comb�nat�on w�th other behav�or change strateg�es. About �,200 male med�cal c�rcumc�s�on leaflets were d�str�buted �n the s�x d�str�cts of Bug�r�, Kal�ro, Kamul�, Iganga, Mayuge, and Namutumba.

2.6PalliativeCare–BasicHealthCareforPLHIVS�x D�str�ct Health Officers were consulted and �nvolved �n select�ng 40 health centers that have the potent�al to �mplement qual�ty pall�at�ve care serv�ces and ART. STAR-EC also met var�ous partners �nvolved �n prov�d�ng

HIV&AIDS-related pall�at�ve care serv�ces and establ�shed collaborat�ve mechan�sms w�th a v�ew of extend�ng the�r serv�ce coverage w�th�n the s�x d�str�cts. For �nstance, STAR-EC concluded plans w�th Hosp�ce Afr�ca Uganda to tra�n 40 health profess�onals �n pall�at�ve care med�c�ne and the use of oral morph�ne. The Program for Access�ble Health Commun�cat�on (PACE) was engaged to supply, at no cost to STAR-EC, the HIV prevent�ve bas�c care package (BCP) starter k�ts to other STAR-EC s�tes beyond the�r current 20 s�tes.

STAR-EC d�str�buted 34 cop�es of the rev�sed M�n�stry of Health (MoH) pre-ART reg�sters and prov�ded 58 home-based care k�ts to 34 health centers across the s�x d�str�cts. Further, STAR-EC prov�ded techn�cal ass�stance to ten health centers wh�ch enrolled a total of 283 (96 male and �87 female) new HIV-pos�t�ve cl�ents �n pre-ART care by conduct�ng cl�n�cal assessments and prov�ded all of them w�th Cotr�moxazole prophylax�s.

E�ght psychosoc�al support groups (two �n each d�str�ct) were formed and supported to meet and encourage PLHIV to adhere to HIV&AIDS and TB treatment.

A PLHIV from Kaliro demonstrates to a Community Support Agent (CSA) how the HBC kit had helped improve the


SUCCESS STORY

FindingHopeAgain

Mutes� Jane �s �0 year old g�rl who was born HIV pos�t�ve. Her parents passed away due to HIV &

AIDS related �llnesses and Jane now stays w�th her grandmother �n Ikumbya par�sh, Ikumbya Sub County, Iganga d�str�ct. Desp�te Jane’s grandmother’s efforts to take care of her, she had cons�stently suffered var�ous �llnesses w�th cont�nuous we�ght loss. In June 2009, a STAR-EC-supported commun�ty support agent v�s�ted the�r home through door to door outreach act�v�t�es to sens�t�ze the commun�ty on HIV&AIDS and TB prevent�on measures �nclud�ng ways of acqu�r�ng treatment. Jane’s grandmother heard the massages and she got �nterested �n shar�ng her granddaughter’s health problems as well as the symptoms that led to the death of her parents. A commun�ty agent was �ntroduced to Jane and �n h�s remarks he noted that “Jane was weak and bedr�dden and could hardly walk or eat food. The grandmother had dec�ded to h�de the l�ttle g�rl for fear of be�ng laughed at by the ne�ghbors.”

After real�s�ng Jane’s s�gns and symptoms, the

commun�ty support agent attached to NACWOLA, w�th support from STAR-EC, adv�sed Jane’s grandmother to take her for both TB and HIV test�ng. A referral form was �ssued d�rect�ng and �ntroduc�ng her to Ikumbya Health Center III �n Iganga D�str�ct. Unfortunately, Jane tested pos�t�ve

for both TB and HIV. She was started on treatment �n June 2009 and the CSA cont�nued support�ng her through home v�s�ts and encourag�ng her together w�th her grandmother psycholog�cally.

Jane’s health has �mproved and she now plays w�th k�ds her age. Those who saw her before treatment can not bel�eve how

healthy she �s �ncreas�ngly becom�ng. “She w�ll soon start school”, says her grandmother, who �s so rel�eved and apprec�ates the s�mple v�s�t from the CSA that has g�ven l�fe and happ�ness to her home. Jane �s one example of the many ch�ldren �n Iganga who have benefited from the Commun�ty Network Support Agents supported by STAR-EC who carry out door-to-door mob�l�zat�on and home v�s�ts to �dent�fy and support PLHIV and the�r fam�l�es.

Table 4: Number of HIV-positive individuals who received Palliative care services

Districts Males Females TotalBug�r� �3 34 47Iganga 22 50 72Kal�ro �8 24 42Kamul� 22 40 62Mayuge �� 28 39Namutumba �0 �� 2�Total 96 187 283

What is working well• Peer-led adherence support through commun�ty support agents contr�butes s�gn�ficantly to treatment

adherence. These commun�ty workers can comb�ne many serv�ces dur�ng home v�s�ts �nclud�ng referrals and d�str�but�on of home-based care k�ts to PLHIV.

Challenges and the Way Forward• Stock out of ARVs and septr�n �n fac�l�t�es that prov�de ART affects adherence and de-mot�vates cl�ents

who travel long d�stances to the health fac�l�t�es. STAR-EC �s support�ng health fac�l�t�es �n log�st�cs management and ensur�ng t�mely request of drugs.

• St�gma deters many people from access�ng serv�ces part�cularly from serv�ce outlets establ�shed �n places near the�r homes. The program w�ll cont�nue to tra�n and fac�l�tate commun�ty-based workers to conduct commun�ty d�alogues on �ssues of st�gma and d�scr�m�nat�on.


Annual Report, October 2009 | �0

2.7PalliativeCare–HIV/TBW�th techn�cal ass�stance from STAR-EC and the Tuberculos�s Control Ass�stance Program (TB CAP), the s�x partner d�str�cts were supported to develop annual TB workplans. Part�cular attent�on was pa�d to those act�v�t�es that a�m to decrease the burden of TB among people l�v�ng w�th HIV and v�ce versa as well as TB �nfect�on control. STAR-EC also part�c�pated �n meet�ngs on the development of TB data collect�on and support superv�s�on tools. Commun�ty mob�l�sat�on and TB d�agnos�s and treatment serv�ces were pr�mar�ly prov�ded by URHB. A total of 48 �nd�v�duals were tested for TB and �3 tested pos�t�ve. Four of these rece�ved TB treatment and the rest were referred by URHB to nearby health centers due to a shortage of TB drugs. STAR-EC obta�ned 800 TB/HIV posters, �20 TB/HIV d�rector�es, 25 cop�es of TB/HIV fl�p charts from the M�n�stry of Health

and Health Commun�cat�ons Partnersh�p (HCP) for d�str�but�on �n the 6 EC d�str�cts. Twenty five health fac�l�t�es rece�ved a TB/HIV fl�p chart each for counsel�ng cl�ents on TB/HIV.

2.8AntiretroviralTherapy(ART)Dur�ng PY�, four ART s�tes rece�ved support from STAR-EC �nclud�ng two former TREAT project s�tes (Kamul� M�ss�on and Iganga Hosp�tals) wh�ch were handed over to STAR-EC by Jo�nt Cl�n�cal Research Center (JCRC). W�th techn�cal ass�stance from the Supply Cha�n Management Systems (SCMS) project, STAR-EC suppl�ed these two hosp�tals w�th four months stock of ant�retrov�ral (ARV) med�c�nes meant for 463 pr�or ART cl�ents (taken over from JCRC) plus 400 new ART cl�ents. Del�very of drugs d�rect to the serv�ce outlets was done by Jo�nt Med�cal Stores (JMS) under a memorandum of understand�ng w�th STAR-EC.

In collaborat�on w�th Uganda Cares and MoH, STAR-EC tra�ned �9 health workers (3 doctors, 8 cl�n�cal officers, and 8 nurs�ng officers) from four hosp�tals (Kamul� M�ss�on, Kamul� D�str�ct, Iganga, and Bug�r� hosp�tals) �n comprehens�ve HIV&AIDS treatment �nclud�ng ant�retrov�ral therapy (ART) w�th the a�m of �ncreas�ng the prescr�ber base and thus �ncreas�ng access to ART serv�ces w�th�n each hosp�tal.

In add�t�on, the four hosp�tals rece�ved on-job mentorsh�p on ARV log�st�cs management from STAR-EC ma�nly focus�ng on report�ng and order�ng for ARVs from the Nat�onal Med�cal Stores (NMS). Hosp�tals were further ava�led w�th the June-December 2009 NMS schedule for ARVs report�ng/order�ng deadl�nes and also prov�ded w�th postage/fax fees to ensure d�rect and t�mely report�ng to NMS s�nce SCMS had closed. Subsequently, the four hosp�tals have �n�t�ated 6� new cl�ents (20 male, 4� female) on ART and treated a cumulat�ve total of 372 current ART cl�ents (�24 male, 248 female) dur�ng the report�ng per�od.

STAR-EC held d�scuss�ons w�th the Cl�nton Foundat�on HIV&AIDS In�t�at�ve (CHAI) and as a result of these d�scuss�ons the program was assured of gett�ng a donat�on of ped�atr�c ARVs �n October 2009. STAR-EC qual�ty �mprovement teams from the d�str�cts of Namutumba and Iganga also part�c�pated �n the qual�ty of care tra�n�ng conducted by the Health Care Improvement (HCI) project. STAR-EC plans to repl�cate the model used by HCI to s�tes �n other d�str�cts.

URHB staff using the TB/HIV flip chart to talk to community members in Bugiri district

�� | Annual Report, October 2009

2.9PolicyAnalysisandSystemsStrengtheningDur�ng PY�, STAR-EC �n�t�ated act�v�t�es a�med at strengthen�ng d�str�cts’ capac�ty to develop HIV&AIDS annualwork plans and budgets. Two workshops (two days each) were conducted �n J�nja where STAR-EC and other partners worked w�th d�str�ct offic�als, �nclud�ng d�str�ct health teams and d�str�ct planners to develop d�str�ct workplans and budgets. In order to enhance ev�dence-based plann�ng, STAR-EC tra�ned a total of 66 personnel w�th�n the operat�on d�str�cts to conduct the annual Lot Qual�ty Assurance Sampl�ng (LQAS) household survey so as to enable results to be �ncorporated �nto the local government annual plann�ng and budget�ng. 350 CSO personnel were tra�ned �n systems strengthen�ng (�05 on �nst�tut�onal capac�ty bu�ld�ng and 245 on HIV commun�ty mob�l�zat�on, prevent�on, care, treatment and HIV-related st�gma reduct�on).

D�str�cts were further supported �n log�st�cs management and health fac�l�ty staff rece�ved on s�te support �n forecast�ng and requ�s�t�on�ng for med�cal suppl�es �nclud�ng test k�ts. Four personnel (stores ass�stant or pharmacy d�spensers) from Kamul� M�ss�on, Kamul� D�str�ct, Bug�r� and Iganga hosp�tals rece�ved on-job mentorsh�p on ARVs log�st�cs management from STAR-EC. Further support to human resources, �nvolved tra�n�ng �9 health workers �n comprehens�ve HIV&AIDS treatment �nclud�ng ant�retrov�ral therapy (ART) from four hosp�tals �n the reg�on.

The object�ve of the two day tra�n�ng was to �mpart knowledge and sk�lls to part�c�pants to �mprove the management of HIV&AIDS pat�ents and ART at the�r respect�ve hosp�tals. Tra�ners were from Uganda Cares and M�n�stry of

Health and altogether 347 people were tra�ned �n the area of pol�cy analys�s and systems strengthen�ng.

ChallengesTo date, �nvolvement of the D�str�ct AIDS Comm�ttees (DACs) and V�llage Health Teams (VHTs) has been l�m�ted. Most d�str�cts have not formed VHTs and �n PY2 STAR-EC w�ll embark on a needs assessment for DACs so that the�r sk�lls and knowledge gaps are addressed and that financ�al support �s prov�ded where necessary. S�m�lar support w�ll be prov�ded to the few already establ�shed VHTs as the program cont�nues to d�alogue w�th the d�str�cts author�t�es regard�ng format�on of more v�llage health teams.

MoH trainer facilitating a session during the Comprehensive HIV&AIDS Treatment Workshop in Iganga

Participants in small groups during district workplanning meetings in Jinja


At the close of Program Year �, STAR-EC’s Strateg�c Informat�on Department had fulfilled most of �ts PY� planned act�v�t�es. Most of the requ�red

M&E staff was recru�ted and d�fferent M&E systems that �ncluded the development of a comprehens�ve M&E plan and PMP were also establ�shed. Some of the accompl�shed act�v�t�es �nclude:

• The execut�on of the LQAS household basel�ne survey �n the s�x East Central reg�on d�str�cts. Th�s survey was conducted s�multaneously w�th the health fac�l�ty basel�ne assessment and �nvolved tra�n�ng 66 part�c�pants (54 from the D�str�ct Local Government and �2 from local CSOs). These part�c�pants were tra�ned on the ent�re LQAS methodology �nclud�ng tools development, sampl�ng, data collect�on sk�lls as well as the actual manual tabulat�on, analys�s, and

report wr�t�ng. Th�s workshop also helped to �dent�fy two LQAS focal persons per d�str�ct (the D�str�ct HMIS focal person and one personnel from the D�str�ct Plann�ng Department) who w�ll be charged w�th the cont�nu�ty and eventual susta�nab�l�ty of LQAS act�v�t�es �n the�r respect�ve d�str�cts. Analys�s of th�s data �s st�ll on-go�ng and results from th�s survey w�ll be d�ssem�nated �n November 2009

• Other accompl�shments �ncluded sett�ng up the STAR-EC webs�te [www.g�veurl�.] as well as an �nformat�on brochure on the key �ntervent�ons that w�ll be executed throughout program l�fe

• STAR-EC also recru�ted a consultancy firm to develop a comprehens�ve web-enabled electron�c database wh�ch w�ll help track all program-level �nd�cators. Th�s database w�ll help to collate all data rece�ved from d�fferent STAR-EC grantees. Add�t�onally, �t w�ll help �n enhanc�ng t�mely report�ng and �s expected to be up and runn�ng by the beg�nn�ng of the second quarter of STAR-EC’s PY2. A backlog of data from program start up as well as on-go�ng monthly data w�ll also be entered �nto th�s electron�c database

• Data collect�on and report�ng tools were developed (by �ntervent�on area) and d�ssem�nated to the four pre-qual�fied STAR-EC-supported CSOs through a mon�tor�ng and evaluat�on tra�n�ng workshop. Local government personnel d�d not take part �n th�s tra�n�ng as there were no act�v�t�es �mplemented by the d�str�cts themselves. STAR-EC plans to conduct further tra�n�ng on the new tools that have been developed �n respect to the New Generat�on PEPFAR �nd�cators

• The Program was able to prov�de four pre-qual�fied CSOs w�th techn�cal ass�stance and support towards data qual�ty �mprovement. V�s�ts to d�fferent CSOs were conducted and support g�ven when gaps were �dent�fied. The CSOs’ capac�ty was further enhanced through the prov�s�on of techn�cal ass�stance on target sett�ng, act�v�ty �mplementat�on and mon�tor�ng, as well as report wr�t�ng

• STAR-EC has also cont�nuously shared d�fferent strateg�c �nformat�on plans and notes w�th the STAR-E program. Both programs’ M&E D�rectorates have shared �nformat�on and lessons learned on var�ous undertak�ngs. Add�t�onally, STAR-EC has collaborated w�th the STAR-E LQAS program on d�fferent act�v�t�es. Other partnersh�ps have been developed w�th the Uganda AIDS Comm�ss�on (dur�ng our basel�ne tools development), the MoH, as well as other USAID-supported organ�zat�ons

Some of the planned M&E activities could not be accomplished by the end of PY1:

• Establ�sh�ng a STAR-EC Resource Center where all program-related mater�als and other l�terature were to be housed. Th�s act�v�ty �s be�ng �mplemented at the t�me of th�s report

• A CSO Organ�zat�onal Capac�ty Assessment (OCA) was also not poss�ble and �s planned dur�ng Program Year 2

• The ut�l�zat�on of D�str�ct HMIS focal persons �n the strengthen�ng of data collect�on at d�str�ct level also d�d not occur. Dur�ng PY2, HMIS focal persons w�ll be fac�l�tated to prov�de support superv�s�on to relevant d�str�ct and fac�l�ty level staff so as to �mprove data qual�ty and ut�l�zat�on across the sectors. Th�s w�ll �nclude strengthen�ng the use of the rev�sed MoH HMIS tools, wh�ch now have HIV&AIDS and TB �nd�cators

A District Local Government staff member taking participants through one of the LQAS training sessions at a workshop in Iganga District

3.0 Strategic Information, Monitoring, and Evaluation

�3 | Annual Report, October 2009

Dur�ng Program Year I, STAR-EC s�gned sub-agreements w�th the four prequal�fied CSO’s total�ng USh 4,�92,5�6,800 for a per�od runn�ng t�ll December 20�3. USh 52�,328,058 was d�sbursed to these CSO’s for the �mplementat�on of PY� act�v�t�es. The four pre-qual�fied CSOs, the Fam�ly L�fe Educat�on

Program (FLEP), the Nat�onal Commun�ty of Women L�v�ng w�th HIV&AIDS �n Uganda (NACWOLA), the Uganda Reproduct�ve Health Bureau (URHB), and Youth Al�ve (YA), part�c�pated �n the STAR-EC start up workshop held �n Apr�l 2009. Among other top�cs covered, th�s workshop �nvolved rev�ew�ng USAID financ�al management gu�del�nes, rules and regulat�ons for grants management. Pr�or to final�z�ng awards w�th each CSO, STAR-EC assessed the�r current financ�al management systems. Dur�ng th�s exerc�se, compl�ance w�th var�ous USAID and STAR-EC pol�c�es and procedures were assessed and �dent�fied gaps were followed up on dur�ng PY�.

In order to m�n�m�ze delays �n CSO act�v�ty �mplementat�on start-up, STAR-EC approved �n�t�al spend�ng of up to a max�mum of USh 97,500,000 for each grantee wh�le final sub-agreements were be�ng negot�ated and executed. By the end of PY�, an average of �2% of the total five year grant funds for the prequal�fied CSO’s had been d�sbursed. Only one CSO (NACWOLA) had not yet rece�ved funds for the final quarter of PY�, wh�le the other three had rece�ved the full PY� d�sbursements. The progress of each grantee was cont�nuously mon�tored and both techn�cal and financ�al management support were offered when gaps were �dent�fied.

Table 5: STAR-EC grantee support, May – September 2009

GranteeTotal Grant

(UGX)2PY1 Budget

(UGX)Total release

(UGX)% Release

Balance on Grant (UGX)

FLEP 999,999,400 �05,092,450 99,999,358 �0 900,000,042

NACWOLA �,088,708,400 ��4,350,600 99,658,600 9 989,049,800

URHB �,027,056,000 �79,00�,500 �78,574,630 �7 848,48�,370

YA �,076,753,000 �43,236,000 �43,095,470 �3 933,657,530

TOTAL 4,192,516,800 541,680,550 521,328,058 12 3,671,188,742

Sub partnersExcept for mother-to-mothers (m2m), all the other three STAR-EC’s sub-rec�p�ents, Bantwana, Commun�cat�on for Development Foundat�on Uganda (CDFU), and Uganda Cares, have already prov�ded techn�cal staff to the STAR-EC program. These �nclude a Capac�ty Bu�ld�ng Spec�al�st, Behav�oral Change Commun�cat�ons Spec�al�st and an HIV&AIDS Spec�al�st. These sub rec�p�ents also part�c�pated �n the STAR-EC start-up workshop. S�m�larly, a finance systems assessment was conducted for both CDFU and Uganda Cares. The expectat�on �s that m2m w�ll have the�r seconded staff �n J�nja w�th�n the month.

5.0 Conclusion

Dur�ng PY�, the program ma�nta�ned a balance of efforts between bu�ld�ng STAR-EC as an �nst�tut�on for del�ver�ng serv�ces and concurrently �n�t�at�ng �ntervent�ons to rap�dly produce results. The ach�evement of targets �n some areas l�ke AB, OP, and tra�n�ngs �s a testament to th�s endeavor. A firm foundat�on on wh�ch scale up of �ntervent�ons w�ll be based �n PY2 has been created. Preced�ng the roll out of planned �ntervent�ons w�ll be the award of grants to add�t�onal CSOs and establ�shment of mechan�sms for del�ver�ng d�rect techn�cal and financ�al support to publ�c health fac�l�t�es. STAR-EC also looks forward to a greater �nvolvement �n techn�cal work�ng groups at the central level w�th a v�ew to �nform�ng pol�cy w�th pract�cal exper�ences from the field.


4.0 Grants and Sub awards


AppendixTable 6: Priority interventions and overall targets for PY2 (October 2009 – September 2010)

Intervention Priority Areas Targets

HIV Testing and Counselling

• Ind�v�duals rece�ved test�ng and counsel�ng (T&C) serv�ces for HIV and rece�ved results

• Ind�v�duals tra�ned �n T&C accord�ng to nat�onal and �nternat�onal standards• Outlets prov�d�ng T&C accord�ng to nat�onal and �nternat�onal standards

70,000

200

80

Prevention of Mother-To-Child Transmission of HIV

• Number of pregnant women w�th known HIV status• Number of mother-baby pa�rs who rece�ved a full dose of ant�retrov�ral

prophylax�s for PMTCT• Ind�v�duals tra�ned �n PMTCT• Outlets prov�d�ng PMTCT serv�ces

7,000

900�6035

Care: Umbrella and Clinical Care

• Number of el�g�ble adults and ch�ldren prov�ded w�th a m�n�mum of one care serv�ce

• Number of HIV pos�t�ve adults and ch�ldren rece�v�ng a m�n�mum of one cl�n�cal serv�ce

• Ind�v�duals tra�ned to prov�de HIV-related pall�at�ve care (exclud�ng TB)• Serv�ce outlets prov�d�ng HIV-related pall�at�ve care (exclud�ng TB)

7,000

2,000

200

80

Clinical/Preventive Services –Additional TB/HIV

• Number of TB pat�ents who had an HIV test result recorded �n the TB reg�ster• Number of HIV pos�t�ve �nc�dent TB cases that rece�ved treatment for TB and HIV

dur�ng the report�ng per�od• Ind�v�duals tra�ned to prov�de HIV/TB related pall�at�ve care • Serv�ce outlets prov�d�ng HIV/TB related pall�at�ve care

500

400

�8080

Antiretroviral Therapy services

• Number of adults and ch�ldren w�th advanced HIV �nfect�on newly enrolled on ART (Is project plann�ng to �ncrease uptake of EID?)

• Number of �nd�v�duals tra�ned to prov�de ART serv�ces• Number of health fac�l�t�es that offer ART

�,500

�00�9

Biomedical Prevention• No. of males c�rcumc�sed as part of the m�n�mum package of MC for HIV

prevent�on serv�ce �,020

Laboratory• Percentage of test�ng fac�l�t�es (laborator�es) that are accred�ted accord�ng to

nat�onal or �nternat�onal standards25%

Sexual and otherbehavioral riskprevention (generalpopulation)

• Number of targeted populat�on w�th �nd�v�dual and/or small group level HIV prevent�on �ntervent�ons that are based on ev�dence

• Number of targeted populat�on reached w�th �nd�v�dual and /or small group level prevent�ve �ntervent�ons that are pr�mar�ly focused on abst�nence and/or be�ng fa�thful, and are based on ev�dence and/or meet the m�n�mum standards requ�red

• Number of MARPS reached w�th �nd�v�dual and /or small group level HIV prevent�ve �ntervent�ons that are based on ev�dence and/or meet the m�n�mum standards requ�red – The planned number to be reach �s very low cons�der�ng the h�gh populat�on of fisher folk �n the project area! MARPS w�ll be an entry po�nt to cover the�r fam�ly members as well.

• Serv�ce prov�ders tra�ned to prov�de abst�nence and/or be�ng fa�thful and MARPS

76,000

50,000

�0,000

400

Strategic Information

• Local organ�zat�ons prov�ded w�th techn�cal ass�stance for strateg�c �nformat�on act�v�t�es

• Ind�v�duals tra�ned �n strateg�c �nformat�on (�nclud�ng M&E, surve�llance and/or HMIS)

�2 (2 per d�str�ct)

65

Policy Analysis andSystems Strengthening

• Ind�v�duals or�ented/tra�ned on the new/rev�sed HIV&AIDS-related pol�c�es and gu�del�nes

�00

Institutional CapacityBuilding

• Ind�v�duals tra�ned �n HIV-related �nst�tut�onal capac�ty bu�ld�ng• Local organ�zat�ons prov�ded w�th techn�cal ass�stance for HIV-related

�nst�tut�onal capac�ty bu�ld�ng

�00

�2 (2 per d�str�ct)

Referrals and Networks • Number of Cl�ents referred for HTC and TB serv�ces• Number of act�ve PLHIV groups �n the EC reg�on

30,00065

�5 | Annual Report, October 2009

STAR-EC HeadquartersPlot 10 Kiira Lane, Mpumudde Division, P.O BOX 829, Jinja

Tel: +256 434 120225, +256 434 120277, +256 332 260182, +256 332 260183

Fax: +256 434 120232

www.starecuganda.org

Kampala Liaison OfficeSTAR-EC

4th Floor, Nakawa House | Plot 3-7 Port Bell Road|P.O BOX 40070, Kampala, Uganda

Tel : (+256) 414 222864, (+256) 312 262164

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