AIC Annual Repoprt 2009 by info ratn

ANNUAL REPORT 2009

Increasing Access to Quality HIV Counselling and Testing

AIC Vision

Universal knowledge of HIV status in Uganda.

AIC Mission

To provide HIV and AIDS information and quality HCT services.

AIC Core Values

AIC Slogan:

Commitment to Excellence

Integrity

Effective Communication

Team Spirit

Timeliness

Continuous Learning

Equal and Fair Treatment to All

Knowledge is Power, Take an HIV Test Today!

Acknowledgement

pecial appreciation goes to all AIC staff for the continuous delivery of quality services during 2009 where tremendous achievements have been registered. A vote of thanks also

goes to our clients who have continued to come for HIV counseling and testing, care and other support services. Recognition also goes to the AIC staff for all the effort that went into providing the information that resulted in the production of this report. A word of appreciation is also extended to the district local governments, development partners and the Civil Society whose financial, material and technical support was instrumental in fulfilling the objectives of AIC during 2009.

Published by: AIDS Information Centre - Uganda P. O. Box 10446 Kampala â&#x20AC;&#x201C; Uganda Telephone: 256 (0) 312 264453/4, 256 (0)414 231528/347603 Fax: 256 (0) 414 270022 Email: informationdesk@aicug.org Website www.aicug.org

Table of Contents ACKNOWLEDGEMENT .............................................................................................................. II LIST OF ACRONYMS AND ABBREVIATIONS ............................................................................ V MAJOR HIGHLIGHTS FOR THE YEAR ........................................................................................ 1 HIV COUNSELING AND TESTING (HCT) .......................................................................... 2 1.0. Background .......................................................................................................................................... 2 1.1. HIV Counseling and Testing ................................................................................................................ 2 1.2. Capacity building of HCT Services in Prisons ...................................................................................... 9

PREVENTION INTERVENTIONS IN AIC ........................................................................ 10 2.0. Background ......................................................................................................................................... 10 2.1 Formation of Know Your Status Clubs ................................................................................................. 10 2.3 Basic Care Package (BCP) Kits ............................................................................................................ 11 2.4 Condom Promotion and distribution.................................................................................................... 11 2.5 Discordant couple club activities ......................................................................................................... 12 2.6 PTC Registration ................................................................................................................................. 12 2.7 Establishment of District PTC’s ........................................................................................................... 12 2.8 YEAH true manhood campaign in Mbarara ........................................................................................ 13

INNOVATIVE APPROACHES TO HCT MOBILIZATION ............................................ 15 3.0 Text to Change SMS Quiz Project ........................................................................................................ 15

GREATER INVOLVEMENT OF PEOPLE LIVING WITH ............................................ 17 HIV/AIDS (GIPA) ......................................................................................................................... 17

iii

4.0 LESSONS LEARNED ............................................................................................................ 17 THE TB/HIV COLLABORATIVE ACTIVITIES IN AIC ................................................. 19 6.0. Background ......................................................................................................................................... 19 6.1. TB/HIV Integration ........................................................................................................................... 19 6.2. TB/HIV Collaborative activities in AIC .............................................................................................. 19 6.3 Key Accomplishments .......................................................................................................................... 20 6.4 Challenges for the TB/HIV Collaborative activities in AIDS Information Center ................................ 20

COMMUNICATION STRATEGY ............................................................................................ 23 7.0 Overview of AIC’s Strategy ................................................................................................................... 23 7.1 Goal ...................................................................................................................................................... 23 7.2 Expected Results ................................................................................................................................. 23

INFORMATION TECHNOLOGY FOR HIV AND AIDS ................................................. 27 PREVENTION IN AIC ................................................................................................................ 27 9.0 Background ......................................................................................................................................... 27 9.1 Key accomplishments ........................................................................................................................... 27 9.2 Opportunities and Challenges .............................................................................................................. 28

A SYSTEMS APPROACH TO STRENGTHENING THE INTERNAL ....................... 31 CONTROLS AT AIC ..................................................................................................................... 31 ANNEX E: AIC PARTNERS AND THEIR TARGET GROUPS ........................................ 42

List of Acronyms and Abbreviations AFB Acid-Fast Bacilli AIC AIDS Information Centre AIDS Acquired Immune Deficiency Syndrome ART Anti Retroviral Therapy BCC Behavior Change Communication BCP Basic Care Package CBDOTS Community Based Directly Observed Treatment CD4/8 Cluster Differentiation (for lymphocytes) 4/8 DHO District Health Officer RHU Reproductive Health Uganda HCT HIV Counseling and Testing HIV Human Immune Deficiency Virus HMIS Health Management Information System IDP Internally Displaced Person(s) IEC Information, Education and Communication SPH School of Public Health IT Information Technology ITN Insecticide Treated Net MARPS Most At Risk Populations MOH Ministry of Health PEPFAR Presidentâ&#x20AC;&#x2122;s Emergency Plan for AIDS Relief PHC Primary Health Care PLHA People Living with HIV/AIDS PPD Purified Protein Derivatives PACE Program for Accessible Health, Communication and Education PTC Post Test Clubs TASO The AIDS Support Organisation TB Tuberculosis UAC Uganda AIDS Commission UBOS Uganda Bureau of Statistics UDHS Uganda Demographic Health Survey UHASBS Uganda HIV/AIDS Sero-prevalence Baseline Survey (2005) UNAIDS United Nations Program for HIV/AIDS UNDP United Nations Development Programme UNHS Uganda National Household Survey USAID United States Agency for International Development UVRI Uganda Virus Research Institute VCT Voluntary Counseling & Testing WHO World Health Organization

Foreword Human Immunodeficiency Virus (HIV) counseling and testing (HCT) remains a pivotal service in the management of HIV/Acquired Immuno-Deficiency Syndrome (AIDS) and a vital entry point to HIV and AIDS prevention and care services. 2009 was a year of considerable growth for AIDS Information CentreUganda (AIC). Among our achievements this year, we registered a total of 422,610 clients served and reached with HCT. This was an increase of 25% from the number reached in the year 2009. AIC continued to apply the integrated approach to HCT service delivery which includes provision of the following services: Family Planning; Sexually Transmitted Diseases treatment; treatment of opportunistic infections including Tuberculosis (TB) and Psycho-social support through Post Test Clubs (PTC).

Hon. Dr. Chris Baryomunsi, Chairman â&#x20AC;&#x201C; Board of Trustees - AIC

AIC acknowledges the continued support from partners in the struggle against HIV and AIDS. The government of Uganda through the Ministry of Health and the Uganda AIDS Commission continued to provide an enabling environment for the provision of HIV/AIDS services through the coordinating roles they play. I would therefore, like to take this opportunity to thank all our partners, donors and Board of Trustees for their continued support. Our success has been a direct result of the continued collaboration and building of relationships. We look forward to continued support and collaboration from all the stakeholders and donors as we continue in our struggle to respond to the HIV and AIDS epidemic.

Hon. Dr. Chris Baryomunsi Chairman Board of Trustees

Executive Summary

AIDS Information Centre-Uganda (AIC) completed its five-year strategic Plan for 2009-2014 that took into consideration the need to reduce new HIV infections (incidence) by 40% by 2012 as the cornerstone of the National Strategic Plan (NSP). AIC outputs were designed to contribute to meeting the Millennium Development goal number 6 which aims at combating HIV and AIDS, malaria and other diseases. During 2009 AIC continued to contribute to prevention under the NSP through activities aimed at providing universal knowledge on HIV counselling and testing. During the year, AIC continued to put special attention to Dr. Raymond Byaruhanga, supporting HIV prevention measures that are mostly cost Executive Director - AIC effective. The organisation also continued to expand her scope in providing HIV counselling and testing, care and support to all her clients. HIV and AIDS, malaria and Tuberculosis remained the main focus of medical services in the organisation. The statistics below reflect AIC’s main achievements during the year: 

422,610 received HIV counselling and testing and received their results



31,038 clients accessed counselling and testing and received results as couples



1,112 prisoners received HCT and got their results in Gulu and Luzira Upper119,612 individuals received abstinence and Being faithful messages through drama and other PTC activities



356,681 individuals received abstinence and Being faithful messages through as part of HCT

 137,663 as part of HCT to youth and children below 24 years  1,197,009 pieces of condoms were distributed to 8,642 individuals  8,299 clients received Basic care packages.  44,861 HIV positive clients were screened for TB  8,387 TB patients were counseled and tested for HIV  967 TB clients co-infected with HIV had their CD4 count tests done  363 TB/HIV co-infected clients were referred for Anti retro viral therapy  1057 participants benefitted from different training programmes Implementation of HIV interventions during 2009 remained within the framework of Uganda’s multi-sectoral response to HIV. This process has laid a firm foundation for continued interventions that contribute to national efforts to address HIV and AIDS, improving quality of life, and access to HIV prevention, care and support services. For 2010 therefore, AIC will mainly focus on consolidating her efforts in cost effective interventions that will enable her to make meaningful contributions to national efforts in reducing the burden of HIV and AIDS, TB and malaria in Uganda.

Dr. Raymond Byaruhanga Executive Director vii

MAJOR HIGHLIGHTS FOR THE YEAR AIC SPEARHEADED THE COUPLE COUNSELING AND TESTING CAMPAIGN

Background: Overall, a total of 91,546 new infections were estimated to occur in Uganda in 2008 among the 13.1 million 1549 year old adult population. Couples in mutually monogamous partnerships accounted for 35.1% of new HIV infections (2009 Uganda HIV Prevention Response and Modes of Transmission Analysis). In light of this apparent trend, AIC spearheaded the Couple Counseling and Testing campaign country wide. This was designed to increase knowledge of HIV status among couples and facilitate dialogue and mutually agreed risk reduction plans among couples. Approaches used: In collaboration with Ministry of Health, Health Communication Partnership (HCP), and other partners, AIC was involved in the design of the national communication campaign promoting HCT among couples; design and development of the training curriculum for couples HCT and training of frontline health workers in the use of the guidelines. HCP also developed and produced IEC materials related to couple HCT and the AIC distribution system was used to disseminate them. Results of the intervention: Since the launch of the couple counseling and testing campaign in October 2009, a total of 1,864 couples have been reached with HCT in the 8 branches of AIC. 89.2% of these couples were concordant negative, 7.0% discordant and 3.8% concordant positive.

HIV Counseling and Testing (HCT) 1.0. Background WHO and UNAIDS classify HIV epidemics into 4 main groups; depending on the HIV prevalence and major modes of transmission (UNAIDS 2007). In a low grade epidemic, HIV prevalence has not exceeded 5% in any sub-population. In a concentrated epidemic, HIV has spread rapidly in a defined sub-population, but is not well-established in the general population. HIV prevalence exceeds 5% in at least one sub-population but is less than 1% in pregnant women. In a generalized epidemic, HIV is firmly established in the general population (prevalence consistently over 1% in pregnant women) and the prevalence in the general population is sufficient to sustain an epidemic independently of transmission from sub-populations at higher risk of infection. In a hyper-endemic epidemic, HIV prevalence exceeds 15% in the adult population, usually driven by extensive heterosexual multiple concurrent partner relationships with low and inconsistent condom use (UNAIDS 2007). Since the first reports of AIDS cases in 1982 in Uganda, HIV has rapidly spread throughout the country resulting into a mature and generalized epidemic with heterosexual contact as the main route of transmission. It has evolved into a heterogeneous epidemic affecting different population sub-groups and resulting in multiple and diverse epidemics with different transmission dynamics. Greater knowledge of HIV status is critical to expanding access to HIV treatment, care and support in a timely manner, and offers people living with HIV an opportunity to receive information and tools to prevent HIV transmission. It is further noted that increased access to HIV testing and counseling is essential in working towards universal access to HIV prevention, treatment, care and support as endorsed by G8 leaders in 2005 and the UN General Assembly in 2006. AIC is a non-governmental organization which was established in 1990 to provide voluntary HIV counseling and testing services and information on HIV and AIDS in Uganda. HIV Counseling and Testing (HCT) is a critical link to effective HIV prevention, care, support and treatment. AIC has 4 core program areas as indicated below: 1.1. HIV Counseling and Testing AIC recognizes the delivery of quality services as one of the vital elements that mobilizes clients for HCT services. Clients who seek for services report having been encouraged by friends and relatives to come to AIC if they want to get accurate results. Word of mouth therefore has remained as one of the ways through which satisfied clients have promoted the utilisation of HCT services offered by AIC. The main strategies in use to support quality assurance and control include: ď&#x201A;ˇ Adherence and utilization of standard operating procedures (SOPs) and protocols. HIV counseling and testing services are provided in conformity with the national SOPs, testing Algorithm and protocols. 2



Technical support supervision. Periodic support supervision sessions are conducted to ensure adherence to the set service delivery standards. This process promotes mentoring and on job training. These sessions also may yield into continuing education sessions or formal training if the gaps cannot be addressed. Continuous education sessions. Monthly sessions are conducted to ensure service providers keep abreast with the dynamic environment. Internal and external experts are utilized during these sessions. Service Improvement Fora (SIF). Service providers hold monthly meetings and quarterly SIF as a means of ensuring quality improvement. Sharing success stories, best practices and case scenario discussion sessions are also held as a means of improving knowledge and skills among service providers.

In spite of Uganda’s commitment to re-invigorate HIV prevention, many people still do not have access to key HIV prevention services. For instance, over three quarters (75%) of all adults, including many people living with HIV do not know their HIV sero-status (2009 Uganda HIV Prevention Response and Modes of Transmission Analysis). AIC provides HCT through its 8 branches (Kampala, Mbarara, Jinja, Soroti, Kabale, Mbale, Arua and Lira). The approaches used include: Stand-alone HCT at AIC branches, Mobile Voluntary Counseling and Testing (MVCT)/Home-to-Home services, Moonlight HCT at night and outreaches targeting mainly the Most at Risk Persons (MARPs) such as commercial sex workers, Internally Displaced Persons, fishing communities, prisoners Table 1: AIC HCT client profile in the year 2009 and the youth. AIC’s intervention 422,610 clients in this area has been very vital in Total tested:  Female: 57% increasing the percentage of people with knowledge about  Male: 43% their HIV sero-status. Total Sero-prevalence: 5.5%  Male prevalence: During the year of 2009, AIC  Female prevalence: recorded 422,610 clients counseled, tested and received Prevalence by Age of Client results. This was an increase of  Below 13 years 25% from the previous year of  13 - 17 years 2008 where a total of 320,000  18-24 years clients were served.(Table 1 below). AIC put emphasis on  25-49 years bringing HCT services closer to  50+ years Most At Risk Populations (MARPS) through outreaches and capacity building of indirect sites.

4.8% 6.1% 4.2% 1.0% 3.4% 8.0% 5.9%

Table 2: Number of people reached with HCT by nature of service outlet January – December 2009 Approach Jan-Mar 09 Apr-June 09 Jul-Sept 09 Oct-Dec 09 Total District sites

40,735

38,882

41,904

31,210

152,731

Main branches

15,398

14,954

12,784

9,946

53,082

Outreaches

75,815

85,199

28,160

27,623

216,797

131,948

139,035

82,848

68,779

422,610

Total

Accurate HIV test results saved a couple’s relationship It was on 8th July 2009 when a couple walked in for HIV Counseling and Testing. Their main reason for accessing HCT was because the woman had tested as an individual the previous year from one of the clinics within Kampala and she was informed that she was HIV positive. She was advised to immediately start taking septrin prophylaxis and even encouraged to go for CD4 count test. However, the woman was sure that she had been faithful to her husband only. When she shared with him the results, the husband agreed that they should start using condoms. As time went by the woman got confused because she could not feel anything like an illness. She continued to talk to her husband who later decided to take an HIV test. They talked to their friend about where they could get credible results for HIV testing and she recommended AIC Mengo Kisenyi. Initially the husband came alone and tested as an individual and his results were HIV negative. This created more confusion as to why he could be negative and while the wife was positive. The counselor however gave all the necessary information and encouraged the man to come with his wife since it was the only way to confirm. They came together the next day and were tested as a couple but their results were both HIV negative. The couple was very happy for having been saved from septrin which the woman had taken for a year. They pledged to keep in contact with the counselor for support.

We thank the organization for such quality work and to show our appreciation will at least come to the branch once a month to see the counselor for more information and guidance. It also makes us happy you look at the building that houses such qualified people with excellent services.

Utilization by Nature of Service Outlet The majority 51% accessed HCT services in outreaches, 36% in district sites and 13% at AIC main branches. This is comparable to 2008 where 42% of the HCT services were accessed in outreaches, 35% in District sites and 23% in AIC main branches.

Utilization of HCT by Gender Out of the 422,610 clients who received HCT during 2009, 57% were female while 43% were male. Female clients are more inclined to know their HIV status as opposed to their male counterparts. This has been the trend for the last five years. It is now expected that with the new program targeting couples, the number of males accessing HCT will increase.

Utilization of HCT by age group The adult age group 25-49 years constituted the majority, accounting for 47% of AICâ&#x20AC;&#x2122;s clients. The youth and children below 25 years accounted for 45%.

HIV Prevalence by age-group The overall sero-prevalence for AIC clients was 5.5% in 2009. This is below the national average of 6.4%. The sero-prevalence was highest (8.0%) among the productive age group (25-49 years) and lowest for those in the 13-17 years and 18-24 years categories at 1.0% and 3.4% respectively. Compared to the prevalence of 2008, there is a slight decrease in both categories from 1.2% and 3.7% respectively. The prevalence among this category of youth has remained low and is continuing to drop. This is an indicator that this age range is continuing to benefit from the targeted interventions including programs on cross-generational sex with the older population, whose prevalence is higher. Specific reference is made to the HIV prevention services by AIC targeting the youth in 9 universities aged 20-24 years, with support from PACE. Individuals 50 years and above registered a prevalence of 5.9%. This is much lower than the prevalence registered in 2008 of 7.6% and the national average of 6.4%. The older age group has benefitted a lot from the couple HCT campaign. HIV Prevalence by Approach Clients at the AIC main branches registered the highest seroprevalence at 10.5%. The clients who come to AIC branches are self selected and most come voluntarily with HIV risk related reasons for testing. The seroprevalence rate among clients reached in the

outreaches has remained the lowest at 4.2%. These groups of clientele are located in hard to reach areas that are often in the rural areas where the sero-prevalence is much lower than that in the urban areas. Couple Counseling and Testing A total of 31,038 clients accessed counseling and testing and received results as couples during the year of 2009. The couples constituted 13.4% of the total number of people in the reproductive age group 25-49 years counseled and tested in AIC. Of the clients counseled and tested as couples, 13,748 (44%) were sexually active at the time of accessing HCT. The majority of the couples who were sexually active at the time of accessing HCT (88.5%) were found to be concordant negative, discordant couples constituted 7.8% and the rest 3.7% were concordant positive couples. HIV discordance is a situation where one member of a couple is HIV negative while the other is HIV positive. The HIV negative partner is at high risk of getting infected with HIV, if the couple does not take steps to protect him or her. According to the modes of transmission study in Uganda (UNAIDS 2009:18), couples in mutually monogamous partnerships account for 35.1% of new infections. HIV prevention among couples is central to AICâ&#x20AC;&#x2122;s prevention strategies, which have been realigned to the changing face of the epidemic in Uganda. AIC established 8 discordant couple clubs to cater for the unique demands of this group. AICâ&#x20AC;&#x2122;s Discordant Couple Clubs have registered 546 couples who are accessing excellent sexual reproductive health services that include the following: 7

   

Support to partners for disclosure, Psychosocial support, with focus on risk reduction of HIV transmission, Sexual reproductive health services including family planning, early diagnosis and treatment of sexually transmitted infections and condom use, Counseling of the discordant couples on prevention of mother to child transmission of HIV.

The Power of the Couple HCT Certificate One time in February 2009, a reverend from Pentecostal Assemblies of God (PAG) church accompanied a couple for HIV Counselling and Testing services. After testing the couple was given a certificate of appreciation for having tested and got result together as a couple. These certificates were provided by HCP. When the reverend saw this certificate he became excited and later decided to come to test with his wife so as to also get a certificate. During counseling, he confessed he had not bothered to take an HIV test saying he knew himself and wife were “safe”. The couple was taken through a counseling session, results were given and subsequently a certificate was given to them in appreciation for having accepted to be counseled, tested and received results together as a couple. The reverend went to his church and talked to his congregation about it. He displayed the certificate to the congregation which amused them. He later mobilized couples and invited AIC to provide HCT services. A total of 67 couples were tested and given certificates. They were excited about certificates and outcomes of their results. Here we learnt that the giving of certificates encouraged the reverend to test, yet he thought he didn’t need the service. He went on to encourage his congregation to test as couples and as a result many people tested as couples, and received information on risk reduction strategies including faithfulness since married couples today are believed to be a high risk group as far as HIV is concerned. Counselors helped couples to openly discuss issues of disclosure and planning for their lives after testing. The Couple HCT Certificate is one of the innovations used during the CHCT campaign to appreciate the couple’s efforts to seek for HCT services together. The Couple HCT campaign is a collaboration between MoH, HCP AIC and other partners that intends to promote and increase HCT service utilization among couples

1.2. Capacity building of HCT Services in Prisons Most-At-Risk Populations (MARPS) are populations in which there is a concentration of risk behaviors for HIV transmission (notably: unprotected sex with multiple partners, anal sex, needle-sharing) that may then drive the majority of new infections; may include commercial sex workers and their partners, long distance truck drivers, fisher folk, uniformed services personnel, men who have sex with men (MSM), injecting drug users (IDU) and prisoners. Vulnerable population groups including women, people with disabilities, young people especially orphans and vulnerable children (OVCs) as well as individuals in marriage or long term sexual relationships. Understanding these groups and their risk to HIV infections would help guide prevention, care and treatment programming as well as targeted service delivery. AIC has made a deliberate effort of mapping out the MARPS and is making targeted interventions that are addressing the drivers of the epidemic in each group of MARPS. Special interventions have been designed and pursued for the following groups:  Couples as highlighted above;  Prisons including the prisoners and the prison warders;  Commercial Sex Workers and their partners;  Long Distance Truck Drivers;  Fishing Communities. During the year of 2009, AIC signed a Memorandum of Understanding with Uganda Prisons Services to provide HCT services in Luzira Upper and Gulu prisons. The main objective was to prevent transmission of HIV and TB through health education, improved access to HIV testing services and TB treatment and prevention services. AIC has since conducted 7 outreaches to Luzira Upper Prison and over 90% of all the prisoners know their HIV status. Over 632 prisoners were tested for HIV and 22 of these were found to be HIV positive. A total of 276 HIV positive prisoners were tested for active and latent TB infection and currently 142 are on Isoniazid prophylaxis. Health worker competencies (knowledge and skills) in relation to comprehensive management of HIV and TB have been built. A total of 480 (94 found positive) prisoners have accessed HCT in Gulu prisons with the support of AIC.

“A total of 55,000 people go in and out of the prisons every year. Good Health in prisons is good public health” as stated by the Commissioner General of Prisons Dr J.O R Byabashaija.

Prevention Interventions in AIC 2.0. Background The goal of prevention in the National HIV and AIDS strategic plan is to reduce the incidence 1 of HIV infections by 40 % by 2012 with a special attention on fully funding those prevention interventions that are most cost-effective. During 2009, AIC branches contributed to this goal by delivering Abstinence (A), Be faithful (B) and Condom (C) messages to clients and the general public. Messages were delivered during education or sensitization talks and during HCT service delivery. Abstinence messages are exclusively targeted at children and youth in Box 2: Summary of Prevention primary and post primary institutions or out of Abstinence/Be faithful (AB) messages school youth and adults who are single and be  119,612 individuals through drama and faithful messages at couples that are married or other PTC activities cohabiting. The other prevention messages  356,681 as part of HCT (OP) are targeted at commercial sex workers, Abstinence only messages (subset of AB) youth in higher institutions of learning, fishing  137,663 as part of HCT to youth and communities, boda boda cyclist, transporters children below 24 years and uniformed personnel. Messages were Other Prevention delivered through the following avenues:  699,717 condom pieces distributed to 8,642 individuals. 6,002 (69%) were males and 2,640 (31%) females.

2.1 Formation of Know Your Status Clubs

In order increase comprehensive knowledge about HIV and to increase access to care and support for clients who have tested HIV positive, referral and prevention efforts targeting the most at risk groups (MARPS), AIC has supported the establishment of Know Your Status Clubs at parish level in 9 districts of Uganda. Activities carried out included consultative meeting with the district health offices and sub counties to reach consensus on the parishes to be selected. Orientation meetings at sub county level were also held that later led to the selection and training of 20 Know Your Status Club members from each parish. A total of 540 members comprising of PHA’s, VHT’s, Posts Test Club members, youth and women were selected. Their responsibilities included conducting home visits to deliver messages on prevention, care and support, TB prevention, Orientation of the Village Health Team in Nyabuhama Parish

Incidence is the number of new HIV infections that have occurred during a period of one year. The emphasis in the NSP is the reduction of new infections. The prevalence of HIV is likely to rise if ART is scaled up significantly.

malaria prevention, positive living, mobilization for HCT, data collection and reporting. 2.2 Psychosocial Support Services to Post Test Club (PTC) members

Orientation meeting with AIC Mbarara staff



A total of 420 clients were provided with on-going psychological counseling this year. The issue addressed included:  Discordance  Stigma and discrimination  Window period  Malaria prevention  PMTCT  Safer sex & Condom use  Family Planning  Disclosure and

Basic care package to PHA’s

2.3 Basic Care Package (BCP) Kits The BCP kit helps in the prevention of opportunistic infections and promotes safer sex among the people living with HIV and AIDS (PLHAs). This service which is beneficial to the PLHA has been provided throughout the year with occasional stock outs. AIC is being supported by PACE in this programme. A total of 8,299 BCP were distributed during the year.

Peer Educator during a monthly meeting at AIC Lira Branch

2.4 Condom Promotion and distribution

A total of 699,717 condoms were distributed during HCT and of these, 6,002 were distributed to males while 2,640 were to females. 497,282 condoms were distributed during PTC outreaches. Of these 233,579 were distributed to males while 263,703. Information on correct and consistent use of condoms and other prevention messages were disseminated to the public during targeted education talks and other ‘….I would like to thank AIC for providing me activities such HCT outreaches, drama with the kits I have been able to live a healthy outreaches and during the counseling sessions. The same information is also life. I no longer fall frequently sick…’(Arua) disseminated by trained condom promoters.

2.5 Discordant couple club activities At all AIC branches, PTC activities include discordant couple activities. AIC introduced an ongoing intervention for HIV discordant couples in February 2001 following a study done in 1998. The study revealed that 1549 (14%) of couples who presented for voluntary counseling and testing (VCT) at the AIC after having sex together were found to be discordant. Couple club members have continued to participate in educational talks, community couple dialogues and discordant couple club fellowship meetings. The involvement of discordant couples support groups has resulted into an increase in the number of couples reached with Abstinence and Being faithful messages. Utilisation of HCT at the AIC branches has increased due to the involvement of discordant couples in mobilization and sensitization.

Couple Club meetings in Jinja (Left) and Lira (Right) ‘…Through the ongoing counseling that I have received, I now know my personal strength and weaknesses. I have believed that this strength has turned me into a resource that HIV cannot breakthrough. It has made me realize a great livelihood and comfort in life. …’(Arua)

2.6 PTC Registration A total of 2,888 new members were registered into PTC this year 1,054 of these were males while 1,834 were females. 2.7 Establishment of District PTC’s Lira branch established 3 PTCs in Acholi sub region this year. These are Awac HC IV in Gulu (with 42 new members of whom 15 are males), Atanga in Pader (with 50 of whom 18 are males) and Kitgum Matidi in Kitgum Districts (with 30 of whom 12 are males). The Lira branch PTC held one Annual General Meeting which attracted 130 members. Members who attended the AGM in Lira

2.8 YEAH true manhood campaign in Mbarara AIC Mbarara Branch is the lead Regional Organisation for Young Empowered and Healthy (YEAH) activities in western Uganda. Activities carried out this year included quarterly YAG meetings, monitoring and supervision visits, training youth groups, tertiary institutions and the police personnel and distribution of IEC materials. Be a Man Campaign Two quarterly meeting were held for Kasese and Ntungamo districts. Three training workshops were conducted for youth groups, tertiary institutions and the police personnel and 5,300 comic books and 60 posters were distributed. Nine communities (LCs) in project areas implemented activities to reduce SRH vulnerabilities of young people out of the 20 that were targeted. The target was not achieved because the organizations lacked funding to implement activities. Twelve organizations have been brought on board to collaborate with AIC on YEAH campaign activities and out of them15 were targeted. Forty five (45) young people (15-24) are now involved in the implementation of Y.E.A.H Young people in Tertiary Institutions being trained

campaign activities at the community level. Implementation has been slow due lack of facilitation for these youth.

True Manhood Campaign One quarterly meeting for Young Advisory Group members was held in Mbarara. A regional stakeholder meeting was held for western region followed by a launch of the true manhood campaign for western region. 5,000 comic books were also distributed.

(Left)Talent show at Reproductive Health Uganda (Right) Procession to the venue of the True manhood Campaign Launch

2.9 Head Office support supervision for quality prevention services The PR, Advocacy & PTC Manager teamed up with the Lab and Medical Services Coordinator, Monitoring and Evaluation Manager and the Counseling and Training Manager to conduct support supervision to Lira branch. Support was given to the branch in the establishment of Know Your Status Clubs and the implementation of Advocacy and Post Test Club activities. The PR, Advocacy & PTC Manager in a discussion with the Lira Branch PTC Supervisor

Lessons Learned    

Radio talk shows, spot messages and announcements if planned well are effective in creating awareness about AIC services and in promoting its image. Strong partnerships have been built through partner & stakeholder meetings held at district level. Confidence and appreciation of services by beneficiaries has been created as strong ties and collaboration between AIC and it’s implementing partners. PTC drama activities have a very big impact in as far as sensitization of communities is concerned

Challenges faced by PTC and Advocacy sectors in the branches:    

IEC materials for promoting AIC services are not adequate. Some of the Y.E.A.H activities are not adequately funded i.e. community discussions using trigger videos, pre-testing Y.E.A.H materials. High transport costs have limited the movement of condom promoters. Clients who have preference for female condoms have not been assisted because they are not available.

Innovative Approaches to HCT Mobilization 3.0 Text to Change SMS Quiz Project Despite all efforts to disseminate information about HIV prevention, comprehensive knowledge about HIV & AIDS in Uganda is still low. While it is assumed that almost everyone has heard about HIV&AIDS, only 30% of women and 40% of men had comprehensive knowledge (2006 Uganda demographic and health survey, UDHS) The HIV incidence rate of 370 people per day and 135,000 people per annum in Uganda is also unacceptably high. The rapid growth of mobile phone technology in Uganda has provided an avenue to reach millions with HIV&AIDS messages in a relatively easy, practical and cost effective way. The Text to Change project which was first pioneered in Mbarara-Uganda and Africa in general is an initiative aimed at increasing awareness on HIV/AIDS through information giving by use of mobile phone text messages, with the desire that this will increase HIV & AIDS awareness, encourage and motivate participants to access HIV Counselling and Testing (HCT) services. Based on the experiences in Mbarara, the TTC /AIC program was aimed at performing an expansion of the Mbarara experience through a roll-out in Uganda starting in Arua targeting 10,000 MTN subscribers. The project was implemented from 28th January– 28th February 2009” at AIC Arua Branch. 3.1 Result of the Intervention Ten Thousand (10,000) MTN subscribers in Arua and West Nile were reached with HIV & AIDS messages. Two thousand one hundred (2, 100) people were directly involved in the HIV SMS quiz. The number of clients accessing HCT services at the branch, other HCT sites in west Nile region and outreaches greatly increased during the project period. A total of 677 (376 Males and 301 Females) clients accessed HCT at AIC Arua branch from 28th January – 28th February 2009. This was one of the highest numbers of clients served in a space of one month as a result of the program and the various interventions employed. The total includes 131 Couples (262 individuals) and 102 individuals who presented SMS text messages before accessing HCT services. (Left) A staff member from Arua branch displays an SMS message. (Below) one of the winners of the SMS quiz after receiving a prize.

Many prizes in form of Airtime and Mobile hand sets were given to the winners of the HIV quiz. Dialogue on HIV and AIDS increased in Arua as those who received the quiz questions shared them with their relatives and friends. The complementary responses received emphasized the correct answers.

Table 2: Summary of results at a glance: No of subscribers reached with SMS messages No. involved in quiz Number of clients who accessed HCT Number of couples served

10,000 2,100 677 M=376 F=301 131 (262 Indiv)

What the beneficiaries had to say: “This program has helped me and my family to know more about HIV and AIDS because each time I got the message, I called my children to help me read and translate the message in Lugbara so that we get the correct answer and win prizes. I am happy that I managed to win air time worth Ten thousand shillings and as well know my HIV status at Kuluva Hospital”. (Watch man from Kuluva hospital)

“I had never made up my mind to test for HIV until I received more that four messages, each encouraging me to test for HIV at AIC Arua. Now that I know my HIV status, I think I will control my lifestyle” A client from Arua share her risk reduction plans after testing HIV negative Because of my busy schedule in school I could not get time to come and test. However when I received more than 10 text messages, I decided to answer the quiz and come to test today. I don’t mind about winning airtime because it has been an exciting experience as I have got a positive reward…knowing my status. I will go and break this good news to my husband so that we shall come together next time. ” A client who benefited from the HCT services Laziyo Eunice, a teacher in Bright Horizon Nursery “I heard you and the AIC Executive Director’s interview on BBC with Joshua Mali on Text to change program for HIV prevention! Good Idea. Keep on the innovation” (A text message from an HIV specialist based in Liberia)

Greater Involvement of People Living with HIV/AIDS (GIPA) In June 1983 in Denver, United States of America, a movement of people living with HIV emerged at the Second National Forum on AIDS. The ‘Denver Principle’ adopted at the forum called for those living with HIV to be supported when they opposed AIDS-related stigma and discrimination. The principle also stated that people living with HIV should “be involved at every level of decision-making, serve on the boards of directors of provider organizations, and participate in all AIDS meetings with as much credibility as other participants, to share their own experiences and knowledge”. The principle of the Greater Involvement of People Living with HIV/AIDS (GIPA) was formally recognized at the 1994 Paris AIDS summit, when 42 countries agreed to support an initiative to “strengthen the capacity and coordination of networks of people living with HIV/AIDS and community-based organizations”. People living with or affected by HIV are involved in a wide variety of activities at all levels of HIV care. AIC fully embraces the GIPA principle and people living with HIV are well represented at all levels including the Board of Trusties (BOT), which is the ultimate decision making body that gives strategic direction to AIC; Branch Advisory Committees (BAC) that oversee activities of the branches and the Post Test Clubs (PTC) and discordant couple clubs that are at the front of AIC’s prevention activities in the community. Experience has shown that involving people living with HIV in a meaningful way is a core element of an effective response to the epidemic. This is central to AIC’s contribution to the response in Uganda. 4.0 Lessons learned     

The Text to Change program is feasible and cost effective. There is a high unmet need for HCT. The program helps to deliver messages without distortion and makes the fight against HIV&AIDS participatory and sustainable as text messages can be stored for a long time and referred to from time to time. The program has a long term effect of increasing knowledge about HIV, addressing myths, misconceptions and taboos surrounding HIV & AIDS and stimulating demand for HIV & AIDS services. The program needs to be complemented with other media approaches such as radio announcements, DJ mentions, posters, testimonies and experiences from those who have accessed services to realize its full potential. The persistent reminders of people through the text messages compel them to test.

Partnership with Bike Holiday to promote HCT AIC entered a collaboration with Bike Holiday which is a group of bicycle activists that raises awareness about health issues that include HIV&AIDS, among the local communities. Two cyclists; Abbey Kisekka and Augustine Muwonge embarked on a campaign tour covering an average of 2,316 km, in 20 days plus 6 resting days. The cyclists were flagged off from AIC Mengo Kisenyi on 1st November 2009 and ended the tour on 26th-November 2009 at the same venue. AIC decided to partner with Bike Holiday because of the shared vision. AIC planned to use this opportunity of the bicycle tour to promote the ‘Go Together Know Together’ campaign; encouraging couples not only to test together but to disclose their status to one another as well for their own well being and that of their children. 5.0 Achievements A total of 26 districts of Uganda were covered in the tour which included eight AIC branches; Kampala, Mbarara, Kabale, Arua, Lira, Soroti, Mbale and Jinja. The team participated in eleven radio talk shows and several HCT outreaches. IEC materials on couple HIV Counseling and Testing were distributed. 5.1 Lessons Learned Sports activities are an important avenue for delivering messages on HIV and AIDS to the community. 5.2 Future Plans The bicycle tour is a new and more adventurous way to create and promote awareness on HIV&AIDS related issues. This tour is only the beginning of a great partnership between AIC – Uganda and Bike Holiday– Uganda.

(Left) The AIC BOT member Mr. Dick Nyai and the AIC Branch Manager and staff of Arua branch receive the Bike Holiday Cyclists at the Branch Offices (Right) The cyclist talk to couples about couple HIV testing at a health facility in Arua

The TB/HIV collaborative activities in AIC 6.0. Background According to the WHO (2009), it is estimated that 9.27 million new cases of TB occurred in 2007 (139 per 100,000 population). Of these 9.27 million new cases, an estimated 44% or 4.1 million (61 per 100,000 population) were new smear positive cases. Furthermore, among the 9.27 million incident cases in 2007, an estimated 1.37 million (14.8%) were HIV positive. A total of 456,000 deaths occurred from TB among HIV positive people (equivalent to 26% of deaths from TB in HIV positive and HIV negative people, and 23% of an estimated 2 million HIVrelated deaths). Uganda is one of the worldâ&#x20AC;&#x2122;s 22 TB high-burden countries, with an incidence of 136 smear positive TB cases per 100,000 people per year [WHO, 2009]. TB is one of the most common causes of morbidity and the leading cause of mortality in people living with HIV and AIDS. HIV is the biggest risk factor for the development of active TB and at present an estimated 39% of TB patients are also co-infected with HIV [WHO, 2009]. The treatment success rate remains low because of the high proportion of patients who die, default from treatment or the treatment outcome is not evaluated (WHO, 2009). 6.1. TB/HIV Integration The rapid growth of the human immunodeficiency virus (HIV) epidemic in many countries has resulted in an equally dramatic rise in the estimated number of new tuberculosis (TB) cases. HIV-related TB continues to increase even in countries with well-organized national TB control programs (NTPs) that are successfully implementing the World Health Organization (WHO) DOTS strategy (the internationally recommended strategy for TB control). This suggests that, where HIV is fuelling the TB epidemic, full implementation of the DOTS strategy is insufficient to control TB and control of HIV infection must become an important concern for NTPs. The high morbidity and mortality from TB among people living with HIV and AIDS (PLWHA) makes TB case detection, treatment and prevention a priority for national AIDS control programs (NACPs). TB and HIV infection co-exist in many people worldwide and HIV and TB programs need to collaborate to relieve the resultant suffering. The unprecedented scale of the epidemic of HIV related TB demands urgent, effective and coordinated action (World Health Organization 2009:1). 6.2. TB/HIV Collaborative activities in AIC The AIDS Information Center started TB/HIV collaborative activities in 2001, with support from the Centers for Disease Control and Prevention (CDC) and the National TB and Leprosy Control Program (NTLP). Over 44,861 HIV positive clients have been screened for TB under this collaboration. Of those screened, 1,072 (2.4%) clients were found with active TB and were started on treatment. Furthermore, AIC has provided HCT services to over 2,600,000 clients since its inception. To date, approximately150,000 clients are counseled tested and provided with results in the AIC system every quarter. This has strategically positioned AIC, with an opportunity to screen all HIV positive clients under the TB/HIV collaboration.

6.3 Key Accomplishments    

Since the beginning of 2009, AIC was able to scale up the sites offering Provider Initiated Counseling and Testing (PITC) to TB patients in 58 sites. A total of 8,387 TB patients were counseled and tested for HIV. A total of 967 TB clients co-infected with HIV had their CD4 count tests done. A total of 363 TB/HIV co-infected clients were referred for Anti retro viral therapy (ART).

6.4 Challenges for the TB/HIV Collaborative activities in AIDS Information Center AIC experienced a number of challenges during implementation of the TB/HIV collaborative activities. These were both system and programmatic challenges and they included: 1. The low levels of knowledge on TB/HIV collaborative activities among staff at the supported sites. This has greatly affected outputs from this collaboration. 2. Lack of skilled health workers in most of the supported sites. The most affected cadre was that of laboratory technicians. 3. Transport for clients on anti-TB drugs. The difficulties in transport have greatly contributed to the loss to follow-up of clients. 4. Throughout the year, there was low integration of reproductive health/FP services in all the 8 AIC branches due to low levels of awareness and irregular supply of RH products,

Partnerships a way to go: CDC Fellowship program, AIC and Uganda Prisons improve uptake of TB/HIV services among marginalized people Prisoners are some of the marginalized and yet hard to reach communities. They lack one of the most often taken for granted liberties; freedom of movement. As a result when one runs out of basic necessities like food, medicines and clothing they have to wait for someone else, prison authorities or their visitors to get the needed items. Time to get such necessities can take as long as weeks or even months, it is worse for those who never get visitors at all. In August 2009 AIC started implementing TB/HIV activities in Luzira upper prison. The implementation of these services was spearheaded by Dr Proscovia Namuwenge a fellow from the Makerere University School of Public Health CDC fellowship program placed at AIC. Services offered to the inmates include HCT, intensified TB case finding, TB prevention among HIV positive inmates, Cotrimoxazole prophylaxis for all positives and medical support for common illnesses and infections to all inmates. The collaboration between AIC and prisons was very timely, it started at a time when the over 280 HIV positive inmates in Luzira upper prison were experiencing challenges in continuity of the supply of Cotrimoxazole. One administrator at the prison gladly commented “I have always longed for a partner to offer services to HIV positive inmates, all other partners preferred to support only staff and their families. AIC you have really helped us” Not only staff have appreciated AIC’s interventions in the prisons, the inmates are overly excited about it too. One inmate who tested HIV negative commented that “now that I know my status, half of my worries are solved”. Another inmate on Isoniazid preventive therapy said, I feel much stronger and happier now since I started taking isoniazid and septrin consistently, before we had to beg our colleagues to share with us the little septrin they had.” By December 2009, AIC had counseled and tested 549 new inmates for HIV, 135 inmates had been started on Isoniazid preventive therapy, and all the 284 HIV positive inmates had a regular supply of Cotrimoxazole. AIC signs a MOU with Uganda Prisons Services in 2009

Despite remarkable success so far registered by the program, it is faced with a number of challenges which include the overwhelming numbers of prisoners who want to know their HIV status, insufficient human resource, lack of established models for HIV care and prevention among prisoners and inadequate funding. In addition, although there are efforts by Government 21

of Uganda to avail health services to prisoners, health care needs with in prison services are unique. They are therefore not well appreciated and rarely attended to within the framework of the mainstream healthcare system leading to perpetual lack of basic essentials like drugs, diagnostic kits, and psychosocial support for the inmates. Due to the challenges mentioned above as well as other logistical problems, the program is still limited to Luzira upper prison one of the four prisons in Luzira complex although MoUs have been signed for expansion to regional prisons including Gulu, Mbarara and Fort- Portal. Thereâ&#x20AC;&#x2122;s overwhelming need that has been demonstrated by this program, but also considering the available capacity it might take time to spread to prisons countrywide. Thereâ&#x20AC;&#x2122;s therefore urgent need to establish partnerships, solicit for additional funding in order to address the urgent need for HIV/TB care and prevention among inmates.

AIC’s Research, Documentation and Communication Strategy 7.0 Overview of AIC’s Strategy AIC has chosen to adopt a strategy that is multi-pronged, seeking to address the weaknesses and challenges identified in its current systems and practices in the areas of research, documentation, and communication. This strategy seeks to uplift AIC’s role in undertaking research, documenting its work, and communicating effectively with internal and external stakeholders. The strategy is therefore focused on how AIC can do better in these areas to satisfy the expectations and needs of its stakeholders, but also to appropriately market and represent itself to the wider publics at local, national and international levels. 7.1 Goal To enhance the role of AIC as a Centre of Excellence in generation and dissemination of evidence-based knowledge in the area of HCT, TB/HIV and other related services. 7.2 Expected Results This strategy addresses four strategic areas, each focused on achieving a specified desired result in the medium term. These desired results are in this document referred to as Intermediate Results (IRs). The intermediate results if achieved are expected to contribute to the realization of the ultimate goal stated above, which is to enhance the role of AIC as a centre of excellence in generation and dissemination of evidence-based knowledge in the area of HCT, TB/HIV and other related services. The four intermediate results are: IR1:

AIC undertakes operational and collaborative research and produces evidence-based knowledge that answers key questions in HCT, TB/HIV, and related aspects.

IR2:

AIC’s work, including innovative approaches, best practices, lessons and experiences are well documented in various forms and disseminated to enhance learning and knowledge sharing

IR3:

AIC’s profile raised and its corporate image improved; it is recognized as playing a significant role in HCT, prevention, care and support, TB/HIV, and other related aspects, and it makes significant contribution to national policy and programming in these matters AIC has adequate capacity to collect and analyze data, document and effectively disseminate information relevant to the needs of its internal and external stakeholders

IR4:

Currently AIC is collaborating with a number of organizations including the CDC fellowship program at the school of public health in regard to implementing the strategy. 23

Capacity Enhancement for Quality HCT Service Delivery 8.0 Training programs conducted in 2009 With increasing demand for prevention, care and treatment services for HIV and AIDS, the Training department worked with various individuals, NGOâ&#x20AC;&#x2122;s, CBOâ&#x20AC;&#x2122;s to build and enhance the capacities of various service providers. This double pronged activity contributed to the delivery of quality HCT services and increased the quantity of existing service providers. The table below shows type of training that was conducted in the period: Type of Training Program Total trained VCT Counselor Training 680 RCT Counselor Training 130 HIV Rapid Testing Training 52 TB/HIV Co-infection Management 71 HIV Peer Education training 41 Train counsellors on child counselling skills 83 TOTAL 1057 Participants in a role play during a training session

Figure 7: The pie-chart below shows the types of training courses that were conducted in the period.

8.1 The Role of Partnerships in Capacity building

Partnerships played a great role in implementing training programmes. 79% (927) of beneficiaries were self sponsored Individuals or those that were sponsored by partners that included HIPS, SCOT, FHI, GOAL-Kalongo, PLAN Tororo, UHSP, UVRI/IAVI, InterAid and TB Cap. 21% (225) beneficiaries were sponsored the development partners that included UHSP and NUMAT. The table below shows type of training by funder: Total Trained by Funder HIV counselling course Total Trained Individuals 173 GOAL-Kalongo 20 NUMAT 312 HIPS 53 SCOT 49 MAVAP 41 FHI 144 UVRI/IAVI UHSP Inter Aid TB Cap PLAN Total

32 103 19 71 40 1057 (Above) A Counselor Training at AIC

A total of 1057 participants attended the various training programmes that were conducted in the period. Of these, 391 (37%) were men while 666 (63%) were women as indicated by the pie-chart below: Figure 8: The pie-chart below shows the number of trainees by gender.

Though more females were served in the period, deliberate efforts continue to be made to increase male involvement in HIV and AIDS interventions including training for the commendable role they play in promoting prevention, treatment and care services.

Participants in a role play and group discussion during a training session

Information Technology for HIV and AIDS Prevention in AIC 9.0 Background AIC uses ICT to provide high quality information about HIV prevalence in Uganda thus creating awareness among the young and the Old. Through this technology data has been collected, analyzed and trends determined. Efforts are increasingly being made to provide accurate data and reports from branches in timely manner through hand held devices and implementation of the Wide Area Network (WAN). In addition, we have other information systems that help in day-today activities such as human resource management, financial management and data management. 9.1 Key accomplishments 9.1.1 Readily available IT systems Information systems, databases, e-mail and Internet are the core systems that must remain available at all times. They also heavily depend on the availability and reliability of power supply in the organization. In the year mitigation of loss of power was done. A total of 44 maintenance free batteries were procured, installed and distributed in 5 branches. 9.1.2 Clients Registration Database AIC consistently maintained an electronic centralized database developed with technical assistance from CDC which captures and stores bio data for clients. The database has both the back end for systems administrators and front end for end users. With its intuitive user interface, the client registration number is auto generated which has eliminated duplication of clients who have visited AIC. Each client is given a unique test number which together with registration number reports number of visits made. A fully integrated HCT system (Client Registry, Testing and Counseling application, electronic Laboratory application, The Care and Treatment application) is under test and yet to be rolled out. 9.1.3 Communication and Internet Access In an attempt to eliminate completely unsolicited e-mails on AICâ&#x20AC;&#x2122;s network, a shift from exchange server to Kerio mail server was done. Through the Webmail Interface, branches have been able to communicate easily to headquarters and world over. E-mail system is the major medium through which data and reports are collected from branches to the headquarters to be stored in the databank. A move to optimize the use of bandwidth in AIC was taken which significantly improved the internet access in branches for timely reporting and easy communication.

Figure 9: Statistics showing SPAMS being detected

9.2 Opportunities and Challenges AIC is bound to perform even beyond expectations if we acquired and integrated modern IT equipment in today’s operations. Mobile wireless handheld devices for example, would enable counselors to quickly enter client’s data while in outreaches and send it to the databank at headquarters. If we acquire modern servers, with redundancy in mind would ensure highly available and fast IT services. Virtual Private Network (VPN) enabled routers would create a secure network over Internet which would culminate into WAN solution. This would ensure faster and efficient data delivery from branches. Online client registry developed by CDC is already being used in Kampala branch and Integrated HCT (IHCT) system is yet to be rolled out. IHCT is a network based system and supposed to be a real-time data delivery system. There are challenges associated with dedicated bandwidth, reliability and efficient servers at HQ. Training and attending International ICT and medical workshops is a key to enhancing knowledge. The fact that IT is at the center of AIC’s operations whose operations are purely medical, the IT staff should be trained to closely correlate IT and medical field.

Using the Team Spirit Approach in maintaining a committed team in AIC Team spirit is one of the seven core values for AIC. A team is defined as a number of people with complementary skills who are committed to a common purpose, performance goals and approach for which they hold themselves mutually accountable. AIC went through a strategic planning process that clarified the ‘Vision’, ‘Mission’ and core values. This process was fully participatory and it laid the foundation for effective team building at all levels. In 2009, AIC invested much time and effort exploring, shaping and agreeing on the set goals and key performance areas of the new strategic plan. 10.0 Retreat At the beginning of 2009, AIC had a human capital of 170 staff, of whom 66 (supervisors, officers, managers and directors) participated in the retreat. The retreat had two phases: the first one consisting of 33 supervisors who underwent a supervisory training for 4 days, and the second one consisting a total of 66 members. The core areas of focus for the larger group were communication, team building and clarification of the team roles. Purpose of the retreat: The main objective of the retreat was to disseminate the approved strategic plan 2009 -2014. The mandate of AIC was re-emphasized, key outputs, AIC opportunities, threats, mission, vision and core values were re-echoed. Other areas covered 

As part of positive re-enforcement, the Chief of party for UHSP emphasized timeliness and encouraged AIC team to write proposals to sustain the funding.



Makerere University Business School gave a talk on ‘Becoming an entrepreneur even



Performance Management was discussed specifically on how to set targets and give feedback. From the strategic plan, branches or departments were to derive the key result areas which flow into branch goals, department goals and on wards to individual contribution.



Other relevant presentations included effective communication, preparing for Media appearance and approaches to increased accessibility of HCT services by AIC



Finance indicated that in order to support the AIC’s Agenda for growth & innovation, they needed to partner more, analyze and predict not only record and report.

when employed, the type of business to engage in, turning hobbies into business and surviving the next month after the layoff’.

10.1 Selecting other team members AIC was joined by 29 staff that brought a wide range of experience and expertise. The organization has different directorates of Program, Operations, Finance & HR/Admin. During the year the Audit department became operational. 10.2 Organisational development As a team determined to succeed, AIC conducted an organizational development (OD) review supported by UHSP. The main purpose was to facilitate AIC to re-assess its current strengths, weaknesses, opportunities and threats and compare and establish workable organizational strategies that would enable it to realize greater organizational performance. It was also meant to enable AIC to learn from its own past success so as to widen its HCT service outreach in an effective and efficient way. Specifically the objectives of the OD were to: Identify ways of building and consolidating appropriate pro-active systems, structures and overall management and governance for greater organization effectiveness.  Identify clear practical time bound recommendation for enhanced organizational effectives. 10.3 Staff development As part of the positive reinforcement, the team carried out various activities that included:

Performance management where training needs were identified and a program made to address them. Secondly a 360 degrees feedback system was used to support staff in getting positive feedback.



One staff attended a laboratory quality management refresher on CD4 testing organized by CDC/BD, M&E focal point training, data management among others.



A supervisory skills training for supervisors was done in conjunction with SPH/CDC. AIC is working with the Fellow to organize various trainings for staff in areas of data, management and technical.



The Branch Manager Arua and HRAD attended a one-week management development program for African managers and leaders of HIV/AIDS organizations by AMREF Nairobi.

10.4 Administration In 2009, AIC purchased a land adjacent its main office in Kampala. Other assets acquired included a double cabin vehicle with support from CDC and 2 land cruisers with support from CSF.

A Systems Approach to Strengthening the Internal Controls at AIC The Internal Auditor has finalised an internal audit manual that focuses on the three core internal audit drivers including: risk coverage, value creation and audit efficiency. He further spearheaded the risk identification and assessment exercises and compiled, AIC Risk Profile and a Risk-Based Annual Audit Plan for 2009 â&#x20AC;&#x201C; 2010. All this was done to ensure that the audits are directed to those high business risk areas. AIC provides HCT and related services across the country through 8 established branches. Branches were therefore identified as places with high operational, financial and compliance risks and hence the need to continuously examine and appraise the effectiveness of the existing controls in detecting and preventing fraud. In this connection, a comprehensive Branch Audit Program was prepared and approved for implementation. This program is currently being piloted in Kampala Branch. â&#x20AC;&#x153;The Internal Audit function plays a very crucial role in not-for-profit organizations, it helps to control fraud and other risks that can publicly impact on their mission and drive donors awayâ&#x20AC;?

Finance

AIC’s main development partners were the Civil Society Fund (CSF), Centers for Disease Control and Prevention (CDC), the Northern Uganda Malaria/HIV/AIDS/Tuberculosis Programme (NUMAT) and the Uganda HIV/AIDS Services Project (UHSP). Funding received was to support HCT and related services, Training, and Operating expenses. We also received support from other partners to further advance the mission and goals of AIC. Some of these organizations include PACE, MRC, YEAH, HCP, CHUSA, PLAN International, CCF as shown in the chart below.

Figure 10: Chart showing funding received

Figure 11: Graph showing funding received versus expenditure on a monthly basis

Major Events for 2009 11.0

AGM and Launch of the Strategic Plan

The AIDS Information Centre– Uganda (AIC) 6th Annual General Meeting was held on 26th June 2009 at the Imperial Royale Hotel.

The 5 year strategic plan for the AIC was launched during this activity. The strategic plan that was prepared by the AIC team with assistance from consultants and financial support from the Development partners will guide the activities and operations of AIC for the period 2009-2014. Some of the achievements of the Board of Trustees (BOT) as presented by the BOT Chairperson Hon. Dr. Chris Baryomunsi include: the review of the AIC constitution, development of BOT manual that is being used to guide the business and conduct of the Board of Trustees. Below is a breakdown of the achievements, challenges and the plans for the future: Achievements  Successfully closed out audit of activities funded by USAID.  Complied with donor requirements in terms of implementation of activities and financial management which has increased donor confidence.  Harmonized all staff salaries to one pay structure, this has increased staff motivation.  Rolled out the Navision Financial Management System to all branches to facilitate capturing, recording and reporting financial information. All the staff in the Finance 33

 

Department was trained in the use of the Financial Management System. Implemented planned activities and achieved targets with minimum funding. This can be shown by the expansion of services provided. In his address, the Executive Director Dr. Raymond Byaruhanga attributed this success to four main factors;  Conducive environment in which the organisation operates  Ever increasing confidence from the development partners through ever increasing funding  Highly motivated AIC team  Good effective over sight by our BOT & BAC Some members of the AIC BOT at the 6th Annual AGM members. of AIC

Challenges AIC faced the following challenges during the year:  Resource base is still low and dependant on donors  AIC membership is low These areas need to be addressed so that AIC can continue to register success in it’s fight to achieve universal knowledge of HIV status in Uganda. Future Plans  Start construction on our HCT centers of excellence in Lira, Soroti and Mbarara  Strengthen partnerships with the private sector  Establishing a fully fledged training centre at AIC Head Office. 11.1 World AIDS day activities World AIDS day is one of the biggest annual global events and the climax of the year’s campaign on 1st every year, to create more awareness on the HIV and AIDS epidemic with an ultimate goal to curb the new infections. The WAD event is a climax of World AIDS campaign provides opportunity to governments, statutory bodies, development partners and all civil society organizations to take stock and evaluate their efforts in checking the spread of HIV in the country. The theme for THE 2009 WAD was: "Universal Access and Human Rights". Five preparatory meetings to organize the national World AIDS event in Uganda took place in October and November 2009 at Uganda AIDS Commission. The meetings were aimed at setting up a National Organising Committee and to map out modalities of implementing this years WAD. The key issues resolve were: Venue, activities and sources of financial resources.

The following events were organized by Uganda AIDS Commission in collaboration with partners. UAC with MoE has organised a children's essay competitions with support from UNICEF. Winners from the districts that participated were be recognized on WAD. National Council for Children organised an Essay Competition as well. The Couple HCT campaign that was launched in September 2008 was to continue through this period. Watoto Church (KPC) organised a bicycle rally ("Race for Hope") that took place on 28th November 2009 and AIC participated by providing free HCT services. Uganda Cares launched an HIV and AIDS campaign targeting HIV negative individuals. A Media "Jam" and Paper "Jam" in form of articles, announcements and supplements was launched by UAC in the papers and electronic media. Media houses joined the campaign and conducted media activities to enable Ugandans access information on HIV and AIDS on WAD simultaneously.

The AIC Exhibition stall

HCT services were provided to couples, individuals and families by various partners that included AIC, MJAP, Inter â&#x20AC;&#x201C; Religious Council; of Uganda, Uganda Cares, Uganda Red Cross and TASO. An appeal was sent out to service providers/health workers to offers services to the public with dignity in the context of Human Rights. Parents were also encouraged to facilitate children to access HIV and AIDS services and information including HCT.

Client’s line up for HCT at the AIC stall in Nakivubo

Teacher also engaged students and pupils into debates to highlight their vulnerability to HIV and AIDS. District health offices should be encouraged to provide HCT in their districts. Ministry of Health conducted films shows on HIV and AIDS using mobile Van with support from CSO’s. IEC materials that included banners, T-shirts and Caps with a WAD message were produced. AIC in collaboration with BIKE HOLIDAY and Uganda Cycling Association conducted an

Achievements Table showing clients served by Kampala Branch NUMBER TESTED HIV POSITIVE LOCATION MALE FEMALE TOTAL MALE FEMALE TOTAL NAKIVUBO STADIUM 187 65 252 7 9 STANBIC BANK 90 56 146 1 1 2 TOTAL 277 121 398 8 3 11

HIV and AIDS / Go together, Know together couple HCT campaign in 8 districts of Uganda. Two professional cyclists toured 24 districts that include the eight AIC branches in 26 days. The tour that was flagged off on 1st December 2009 at AIC Kampala Branch ended on 26th November 2009 at the same venue. The two cyclists participated in radio talk shows and couple HCT outreaches in the eight AIC branches with the aim of promoting the couple HCT campaign. AIC participated in providing HCT at the National venue and showcased her services at an exhibition. 11.2

AIC Participates in activities to commemorate World TB Day – 2009 Cultural performances, processions, exhibitions and speeches filled Masindi town on March 24th 2009. This was the day Uganda joined the rest of the world to commemorate the World TB day. Many organizations come together in solidarity against TB under the slogan “I am stopping TB and controlling HIV”.

The AIC MSC, the GLR Director & TB Program Manager at the AIC stall

A child being tested in the presence of the parents at the AIC stall

AIDS Information centre was no exception as it showcased the services that it provides and also provided HIV Counseling and Testing (HCT) services onsite. AIC also took this opportunity to share its achievements since it started the HIV/TB collaborative pilot program at AIC Kampala branch in 2001. The AIC stall had a number of posters on Couple HCT, child counseling and testing, TB, condoms and a number of brochures on the basic questions on TB were distributed. On display was also the AIC TB protocol. The day saw 24 people turning up for HIV counseling and testing and 400 condoms distributed. Notable among them were parents who decided to have their children tested for HIV. As noted by the WHO Country representative, a large number of patients discontinue treatment, die while on treatment, or are lost to follow up and because of this, AIC started a client follow up program in

2007. In this program, TB clients are visited in their homes to counsel them on adherence and encourage them to come for refills. Complicated cases are referred to specialized TB treatment centers. The progress of the program has been good though the major challenge so far registered is that adherence to TB treatment is still difficult to enforce especially since clients tested and treated for TB are usually HIV positive and would rather not disclose their status to partners and family who ideally should provide support. Non disclosure of HIV status especially among couples hinders treatment since patients fear that their partners will get suspicious of their treatment. Many have also provided wrong addresses to avoid adherence visits to their homes. As the day was coming to a close the Guest of honor re-emphasized Early Diagnosis; Early Treatment; Completion of Treatment and unveiled the sign post â&#x20AC;&#x153;TB is curableâ&#x20AC;?.

Annex A: AIC Board of Trustees Name 1 Hon. Dr. Chris Baryomunsi

Title Chairperson

2 Mrs. Angelina Wapakhabulo Vice Chairperson/High Commissioner to Kenya 3 Prof. Waswa Balunywa

Treasurer/Principal MUBS

4 Hon. Beatrice Rwakimari

Special

Groups

Representative

/Chair

HIV/AIDS

Parliamentary Committee 5 Prof. Charles Rwabukwali

Associate Members’ Representative

6 Mr. Jimmy Ivans Obbo

PTC Representative

7 Hon. Dick Nyai

PLI Representative

8 Dr. Kihumuro Apuuli

UAC Representative

9 Dr. Sam Okware

Ministry of Health Representative

10 Hon. John Emilio Otekat

Member

11 Dr. Kaguna Amooti Bwera

Member

12 Mr. Danson Yiga Mukasa

Member

Hon. Benson Obua-Ogwal

14 Dr. Raymond Byaruhanga

Secretary/AIC Executive Director

Annex B: AIC Board of Trustees Sub-Committees and their membership Programmes/Technical Sub-Committee 1 Dr. Sam Okware

Position Chairperson

2 Hon. Dick Nyai

Member

3 Jimmy Ivans Obbo

“

4 Dr. Kaguna Amooti

“

5 Francis Nahamya

Secretary/AIC Programs Director

Finance Sub-Committee 1 Prof. Waswa Balunywa

Position Chairperson

2 Danson Yiga Mukasa

Member

3 Hon. John Emilio Otekat

“

4 Hon. Benson Obua-Ogwal

“

5 Beatrice Kansiime

Secretary/AIC Finance Director 39

Policy Sub-Committee 1 Mrs. Angelina Wapakhabulo

Position Chairperson

2 Prof. Charles Rwabukwali

Member

3 Hon. John Emilio Otekat

“

4 Hon. Dick Nyai

Member

5 T.Lubandi Samali

Secretary/AIC HRA Director

Resource Mobilisation Sub-Committee 1 Hon. Dr. Chris Baryomunsi

Position Chairperson

2 Hon. Benson Obua-Ogwal

Member

3 Prof. Waswa Balunywa

“

4 Danson Yiga Muksa

“

5 Dr. Raymond Byaruhanga

Secretary/AIC Executive Director

Research Sub-Committee 1 Prof. Charles Rwabukwali

Position Chairperson

2 Dr. Sam Okware

Member

3 Dr. kaguna Amooti Bwera

“

4 Prof. Waswa Balunywa

“

5 Hon. Dick Nyai

“

6 Dr. Raymond Byaruhanga

Secretary/AIC Executive Director

Annex C: Branch Advisory Committee Chairpersons Name

Branch

1 His Worship Alfred Martin Arua

Soroti

2 Mr. Dan Opima

Arua

3 Mr. Jack Mwondha

Jinja

4 Mr. John Alex Muyita

Kampala

5 Mr. Arsen Nzabakurikiriza

Kabale

6 Mr. Peter Owiny Gudozu

Lira

7 Mr. James Turyagyenda

Mbarara

8 Dr. Gideon Wamasebu

Mbale 40

Annex D: AIC Senior Management and Branch Management 2009 Annex D (i) AIC Senior Management at Headquarters Name

Title

1 Byaruhanga Raymond (Dr.)

Executive Director

2 Nahamya Francis

Programs Director

3 Tibenda Lubandi Samali

Human Resource and Administration Director

4 Beatrice Kansiime

Finance Director

5 Mugalya Ndoboli Abel

Operations Director

6 Ahumuza Godfrey

Information Technology Manager

7 Tumuhairwe Kellen

Training Manager

8 Kivumu Ssimbwa Michael

Internal Auditor

10 Katamba Henry (Dr.)

Monitoring and Evaluation & Ag Clinical Services Manager

12 Lukenge Daniel

Public Relations and Advocacy Manager

13 Rwakajara Arthur

Finance Manager

Annex D (ii) Branch Management Branch Name of Branch Manager

Number of Staff

Arua Branch

Lulu Henry Leku

Jinja Branch

Twesigye Loy

Kabale Branch

Kikaffunda Richard

Kampala Branch

Kabugu Tom

Lira Branch

Wantate David

Mbale Branch

Wanamama Sam

Mbarara Branch

Berigija Alice

Soroti Branch

Katongole Drake

Annex E: AIC Partners and their target groups Partner African Palliative Care Association (APCA) All government of Uganda ministries Baylor College of Medicine Childrenâ&#x20AC;&#x2122;s Foundation-Uganda Centers for Disease Prevention and Control (CDC) Christian Childrenâ&#x20AC;&#x2122;s Fund Church of Uganda-CHUSA

Target group General Population Staff Children Tuberculosis Clients General Population General Population

Civil Society Fund (CSF) Community Empowerment Initiative Compassion international Health Communications Partnership

MARPS General Population General Population Couples Counselors from private companies. Couples General Population Market vendors Couples Couples Youth

Heath Initiatives for the Private Sector International AIDS Vaccine Innitiative (IAVI) Kawempe Home Care Market Vendors AIDS Project (MAVAP) Medical Research Council Medical Research Counsel (MRC) Naguru Teenage Centre

Northern Uganda Malaria, HIV/AIDS and TB Program (NUMAT) General Population Plan International General Population Population Services International (PACE) Youth Strengthening Counseling and Testing (SCOT) Counselors The AIDS Support Organization (TASO) Staff Trans-cultural Psycho-Socio Organisation (TPO) General Population Uganda Health Marketing Group General Population Uganda Health Services Project (UHSP) General Population Uganda People's Defence Force (UPDF) Uniformed Men & Women Uganda Police Force Uniformed Men & Women Uganda Prisons Services (UPS) Prison inmates Uganda Red Cross Society (URCS) General Population Uganda Virance Research Institute (UVRI) General Population United Nationd Fund for Population Activities (UNFPA) General Population World Vision General Population Young Empowered and Healthy (YEAH) Youth

HEAD OFFICE Plot 1321 Musajja –Alumbwa Road P.O. Box 10446, Mengo-Kisenyi Kampala – Uganda Telephones: (+256) 414 231 528, 414 347 603, 312 264453/4. Kampala, Uganda Email : informationdesk@aicug.org | Website www.aicug.org

REGIONAL SERVICE CENTRES Kampala Office Plot 3121 Musajja –Alumbwa Road P.O. Box 10446, Mengo -Kisenyi Telephone: (+256) 414 576 535 Kampala, Uganda Email: aickampalabranch@aicug.org

Lira Office Plot 5, Dokolo Road P.O. Box 156, Lira Telephone (+256) 4734 20861 Lira, Uganda Email: aiclirabranch@aicug.org

Mbarara Office Plot 11 Ruhara Road P.O. Box 1055, Mbarara Telephone: (+256) 4854 21384, 4854 20876 Mbarara, Uganda Email : aicmbararabranch@aicug.org

Soroti Office Plot 2 Oculoi Road P.O. Box 62, Soroti Telephone (+256) 4544 61058 Soroti, Uganda Email : aicsorotibranch@aicug.org

Kabale Office Plot M24 Rwakiseta Road Kirigime P.O. Box 373, Kabale Telephone: (+256) 4864 22254 Kabale, Uganda Email : aickabalebranch@aicug.org

Mbale Office Plot 2 Mugisu Walker Hill, Pallisa Road P.O. Box 1838, Mbale Telephone (+256) 4544 33333 Mbale, Uganda Email : aicmbalebranch@aicug.org

Arua Office Plot 34, Iddi Amin Road - Oli P.O. Box 550, Arua Telephone (+256) 4764 20508, 4764 20057 Arua, Uganda Email: aicaruabranch@aicug.org

Jinja Office Plot 17 Bell Avenue West P.O. Box 2159, Jinja Telephone (+256) 4314 20890 Jinja, Uganda Email : aicjinjabranch@aicug.org