Project Title:
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Expanding Anti-Retroviral Therapy and Care and Support of Orphans and Other Vulnerable Children |
| Country: |
Uganda |
| Round: |
3 |
| Principal Recipient: |
The Ministry of Finance, Planning and Economic Development of the Government of Uganda Contact |
| Local Fund Agent: |
PricewaterhouseCoopers Contact |
| Portfolio Manager: |
Bampoe, Victor Contact |
| Grant Agreement Signed: |
01-Oct-04 |
| Grant Start Date: |
01-Nov-04 please note that... |
| Total Funding Request: |
$118,565,707.00 |
| Approved Funding: |
$70,357,632.00 |
| Total Funds Disbursed: |
$7,496,382.00 | |
Summary: It is estimated that about 100,000 people are living with AIDS in Uganda. Of these, only 10,000 AIDS patients are currently on antiretroviral drugs (Draft Report on rapid Assessment of Access to Anti-Retroviral Therapy in Uganda prepared by MOH, 2002). Although HAART has been available in Uganda since 1998, it is not provided to the wider public through the public health systems. It has been confined to NGOs, commercial providers, research and pilot project. Most of the patients on treatment live in urban areas and pay entirely from out of pocket or cost share with their employers. PLWA already enrolled in care and support programs in not-for-profit organizations are in need of ARV's while they already have access to a comprehensive package of care. TASO has 30,000 HIV positive clients of whom 10,000 are in need of
ARV's.
With the recent reduction in the prices of ARV drugs combined with availability of high quality generic drugs, often in fixed dose combination, and strengthened health system, the Government is now committed to make ART progressively accessible to the public. The resources sought from the GFATM will only complement ongoing efforts by government, private sector, and development partners.
Objectives:
The project proposes to attain these goals through six interrelated specific objectives.
- to increase the number of people receiving antiretroviral drugs from 10,000 to 30, 000 through a public private partnership in 26 facilities by end of the project period.
- to expand the national capacity to monitor and supervise ARV drug resistance.
- to expand and strengthen the capacity to provide family counselling to help people cope with the adjustment to treatment and the implications of having a life -threatening disease and to understand the importance of adherence to treatment through community support.
- to build upon efforts funded through the first approved Uganda Global Fund proposal and further strengthen voluntary counselling and testing (VCT) capacity to provide information on antiretroviral treatment (ART), to reinforce prevention counselling and to stress HIV potential transmission, even while on ART, when demand for additional test is expected to increase.
- to strengthen logistic systems (including, forecasting, procurement, storage, inventory management, information systems, distribution) to ensure consistent, secure and timely availability of quality ARV drugs and supplies at service delivery points.
- to promote behavior change among people living with AIDS (PLWA) treated with ARV and to raise awareness of the public health implications of non-compliance.
Target groups/Beneficiaries:
- Patients living with AIDS and their families
- Special Groups (pregnant women, orphans and vulnerable children, PLWA enrolled in care and support programs)
- Health system & health workers of public and private sector
- Community-based organization
Goal:
This proposal aims to move forward implementation of the Ugandan Antiretroviral Drug (ARV) Policy. By equitably expanding the use of antiretroviral drugs (ARV) in Uganda through a public private partnership, the overall goals of the ARV component of the project are (1) to reduce overall morbidity and mortality due to AIDS, (2) to lower the HIV sero-prevalence in the country by the end of 2007.
Planned Activities:
To achieve these objectives, the main activities implemented are: (1) to provide ARV's to treat PLWA with a focus on mothers previously enrolled in PMTCT programs, orphans and vulnerable children, and the PLWA already enrolled in care and support programs; (2) to set up a referral system for the monitoring of drug resistance in 26 ART centers; (3) to train counselors, community health educators, caretakers and members of community organizations to cover the issues of ART a
nd to
develop ART-counseling training materials; (4) to sensitize VCT patients on the benefits and limitation of antiretroviral treatment (ART) and to develop patient's education material; (5) to enhance the forecasting and procurement of drugs, to expand the pilot phase of the Health Management Information System (HMIS) and to strengthen the security procedures for ARV drugs; and (6) to develop information campaign through ART-focused information, education and communication (IEC) and behaviour change communication (BCC). It is hoped that these interventions will contribute to the global targets of lowering HIV seroprevalence among adults to 3.1% and reduce the number of death from AIDS to 81,000 per year by 2007 through a number of outputs. These outputs include expanding the antiretroviral ARV drugs delivery through 26 institutions, which have access to the infrastructures necessary to monitor HIV viral resistance, to 30,000 PLWA at the end of the project including 12,000 mothe
rs and
their families reached through the PMTCTplus and 11,000 PLWA already enrolled in care and support services. The proportion of families supporting patients on ART and of community health workers exhibiting knowledge in ART counselling should reach respectively 95% and 85% with a baseline of 40% and 65%. The number of health-unit-based VCT services providing ART-counselling services will be 26 at the end of the project. By year 2007, 100% of first line ARV's and selected lab reagents are expected to be available at 26 ART centres. As a result of IEC and BCC campaigns, the proportion of the target population adopting behaviour change and adhering to ART while on ARV should reach respectively 90% and 95%, with a baseline of 80% and 85%.
Expected Results:
- Improved access to HIV/AIDS care especially treatment, increased counseling, less default and less risks of ARV drug resistance, increased community participation in ART, decreased costs of opportunistic infection care
- Improved access to ARV therapy, improved prospects for VCT and PMTC, enhanced AIDS control measures, improved socio-economic outcomes
- Strengthened health system, trained health workers, increased VCT and PMTC utilization due to availability of ARV drugs
- Create a partnership for ensuring for an effective response to ART, involved in patient screening and compliance follow up process
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