STRENGTHENING UGANDA’S SYSTEMS FOR TREATING AIDS NATIONALLY FINAL REPORT JUNE 2010 – SEPTEMBER 2018 Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN) is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement number 617-A-10-00007-00. The project team included prime recipient University Research Co., LLC (URC) and sub-recipients; The AIDS Support Organization (TASO), Integrated Community Based Initiatives (ICOBI), Initiatives, Inc., and Health Research, Inc, Uganda Catholic Medical Bureau (UCMB), Child Chance International (CCI), ACLAIM Africa Ltd, Uganda Protestant Medical Bureau (UPMB), Uganda Muslim Medical Bureau (UMMB) and AIDS Information Centre (AIC). USAID Strengthening Uganda’s Systems for Treating AIDS Nationally Final Report June 2010 – September 2018 Submitted to: Hilda T. Asiimwe, USAID Agreement Officer Representative Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN) is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement number 617-A-10-00007-00. The project team included prime recipient University Research Co., LLC (URC) and sub-recipients; The AIDS Support Organization (TASO), Integrated Community Based Initiatives (ICOBI), Initiatives, Inc., and Health Research, Inc, Uganda Catholic Medical Bureau (UCMB), Child Chance International (CCI), ACLAIM Africa Ltd, Uganda Protestant Medical Bureau (UPMB), Uganda Muslim Medical Bureau (UMMB) and AIDS Information Centre (AIC). DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development of the United States Government. On the cover: An HIV-positive mother shows off her babies born free of HIV virus following PMTCT interventions. Opposite: A patient receives HIV testing at a SUSTAIN supported healthcare facility. Table of Contents Acronyms ................................................................................... iv Executive Summary ...................................................................v Introduction ................................................................................1 Project Overview ........................................................................3 What We Did ...........................................................................3 Project Objectives ...................................................................3 What We Achieved .....................................................................6 Partnerships and Collaborations ..............................................7 How We Worked .........................................................................9 Focus Areas .............................................................................10 HIV Testing Services ..............................................................10 Prevention of Mother-to-Child Transmission ..........................12 HIV Care and Treatment ........................................................15 TB/Multidrug-resistant TB .....................................................20 Community-Facility Linkages .................................................25 Voluntary Medical Male Circumcision ....................................27 Nutrition.................................................................................30 Supply Chain .........................................................................32 Laboratory Services ..............................................................34 Adolescent-friendly Health Services ......................................39 Health Management Information Systems .............................41 Human Resources for Health ................................................43 Quality Improvement .............................................................46 Challenges ................................................................................49 Contextual Opportunities ........................................................49 Annex 1: Lessons Learned .................................................... A-1 Annex 2: Performance Monitoring Plan ............................... A-5 Annex 3: Project Publications ..............................................A-17 Annex 4: Stewardship Assessment Checklist ................... A-23 Annex 5: Success Stories .................................................... A-24 Annex 6: Awards and Recognitions .................................... A-34 Annex 7: Financial Summary ............................................... A-35 Opposite: Amony Concy, 22 years, was treated for MDR-TB at SUSTAIN supported Gulu RRH and is now fully recovered. September 30, 2018 | Final Report iii List of Acronyms S 5 Sort, Set, Shine, Standardize, LTFU Loss to Follow-up SPARS Supervision, Performance and Sustain MARPI Most at Risk Populations Assessment, and Recognition AFHS Adolescent-Friendly Health Initiative Strategy Services MDR-TB Multidrug-resistant Tuberculosis SPNO Senior Principal Nursing Officer AIC AIDS Information Centre MTC Medicines and Therapeutics STAR Strengthening TB and HIV & C AN Antenatal Care Committees AIDS Responses Project ART Antiretroviral Therapy MoH Ministry of Health SURE Securing Uganda’s Right to Essential Medicines ASSIST Applying Science to Strengthen NACS Nutrition Assessment, SUSTAIN Strengthening Uganda’s and Improve Systems Project Counseling, and Support Systems for Treating AIDS CBC Complete Blood Count NMS National Medical Stores Nationally Project CCI Child Chance International NTLP National TB & Leprosy Program TASO The AIDS Support Organization CD4 Cluster of Differentiation 4 OpenMRS Open Medical Records System TB Tuberculosis CPHL Central Public Health PCR Polymerase Chain Reaction THALAS Targeted HIV/AIDS and Laboratories PEPFAR U.S. President’s Emergency Laboratory Services Project CQI Continuous Quality Plan for AIDS Relief TREAT Timetable for Regional Improvement PITC Provider-initiated Testing and Expansion of Antiretroviral DR-TB Drug-resistant Tuberculosis Counseling Therapy Program EID Early Infant Diagnosis PMTCT Prevention of Mother-to-Child UCMB Uganda Catholic Medical EMR Electronic Medical Record Transmission of HIV Bureau eMTCT Elimination of Mother-to-Child PNFP Private Not-for-profit UEC Uganda Episcopal Conference Transmission of HIV PREFA Protecting Families Against UKNEQAS United Kingdom National EQA External Quality Assurance HIV/AIDS External Quality Assessment OU G Government of Uganda I Q Quality Improvement Service UMMB Uganda Muslim Medical Bureau HAART Highly Active Antiretroviral RHITES Regional Health Integration to Therapy Enhance Services Project UNAIDS Joint United Nations Program on HIV/AIDS HIV Human Immunodeficiency Virus RMEMW Regional Medical Equipment UPMB Uganda Protestant Medical HMIS Health Management Information Maintenance Workshop Bureau System RRH Regional Referral Hospital URC University Research Company, R H Human Resources RUTF Ready-to-use Therapeutic Food LLC HRH Human Resources for Health SANAS South African National USAID United States Agency for Accreditation Service HRPI Human Resource Performance International Development Improvement SCMS Supply Chain Management VMMC Voluntary Medical Male HTC HIV Testing and Counseling Systems Circumcision HTS HIV Testing Services SLIPTA Stepwise Laboratory Improvement Process Towards WHO World Health Organization IAC Intensive Adherence Counseling Accreditation WHO/AFRO WHO Africa Regional Office ICOBI Integrated Community Based SLMTA Strengthening Laboratory YCC Young Child Clinic Initiatives Management Towards IDI Infectious Disease Institute Accreditation IEC Information, Education, and SMS Short Message Service Communication iv USAID | SUSTAIN Strengthening Uganda’s Systems for Treating AIDS Nationally Executive Summary he Strengthening Uganda’s Systems for Treating AIDS n Per the U.S. President’s Emergency Plan for AIDS Relief Nationally (SUSTAIN) project, supported by the United (PEPFAR), strengthen Human Resources secondments for T States Agency for International Development (USAID), public and private health facilities at health units in Uganda. was awarded in June 2010 to support the Ugandan Ministry of The USAID/SUSTAIN project has been a pacesetter for the Health (MoH) to strengthen systems for the delivery of quality last eight years of national programmatic changes to the HIV/ HIV/TB prevention, care, and treatment services at selected TB response. The project efficiently rolled out national policies regional referral and general hospitals. USAID/SUSTAIN wa at regional referral hospitals by supporting implemented by University Research Co., LLC pilot-testing of each change using short- in collaboration with two international partners In the year 2014, the learning-cycle pretests. This work yielded (Health Research, Inc./HealthQual, and Initia- project was recognized several novel innovations, such as the HIV tiExves, Inc.) and eight local partners: The AIDS among the top 10 best screening tool, order checklist, cell phone Support Organization, Integrated Community text-based reminders for reporting, and Based Initiatives, ACLAIM Africa Ltd., Child worldwide HSS projects facility performance reviews, which have Chance International, AIDS information Centre, by USAID Washington been adopted at the national level and scaled Uganda Catholic Medical Bureau Uganda Prot- up by the other