Strengthening TB and Hiv&Aids Responses in East-Central Uganda (Star-Ec)

STRENGTHENING TB AND
HIV&AIDS RESPONSES IN
EAST-CENTRAL UGANDA (STAR-EC)
PROGRAM YEAR VI, QUARTER 3 PROGRESS REPORT
APRIL- JULY 2014
THE REPUBLIC OF UGANDA
Funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States
Agency for International Development (USAID) under the terms of Cooperative Agreement No.
617-A-00-09-00007-00
Disclaimer
This report is made possible by the generous support of the American people through the President’s Emergency Plan for AIDS Relief (PEPFAR)
and the United States Agency for International Development (USAID). The contents are the responsibility of JSI Research & Training Institute,
Inc. and do not necessarily reflect the views of PEPFAR, USAID, or the United States government.
© 2014
Financial support for this program is provided by United States Government through USAID, under Co-operative Agreement number
617-A-00-09-00007-00. The views expressed in this document do not necessarily reflect those of USAID.
This program is implemented by JSI Research & Training Institute Inc.,in collaboration with World Education’s Bantwana
Initiative, Communication for Development Foundation Uganda, mothers2mothers, and Uganda Cares.
Quarter THREE Progress Report
Table of Contents
Table of Contents......................................................................................................................................................................................................i
List of Boxes . ...........................................................................................................................................................................................................02
List of Figures............................................................................................................................................................................................................02
List of Tables ............................................................................................................................................................................................................03
List of Acronyms.......................................................................................................................................................................................................04
Executive Summary...................................................................................................................................................................................................06
1.0 Introduction.........................................................................................................................................................................................................1
1.1 Brief overview of STAR-EC.................................................................................................................................................................................1
2.0 Priority intervention areas during Quarter 3, PY6...............................................................................................................................................2
2.1 HIV testing and counseling (HTC) ......................................................................................................................................................................2
2.2 Virtual elimination of mother-to-child transmission (eMTCT) of HIV.................................................................................................................4
2.3 Voluntary medical male circumcision (VMMC)...................................................................................................................................................7
2.4 Combination HIV prevention ..............................................................................................................................................................................9
SUCCESS STORY......................................................................................................................................................................................................10
SUCCESS STORY......................................................................................................................................................................................................11
2.5 Care and Support................................................................................................................................................................................................13
2.5.2 Pediatric care...................................................................................................................................................................................................15
2.5.4 Support care.....................................................................................................................................................................................................18
2.6 Antiretroviral therapy (ART)................................................................................................................................................................................19
2.7 Clinical/additional TB/HIV..................................................................................................................................................................................21
2.8 STRENGTHENING LABORATORY SERVICES DELIVERY ...................................................................................................................................24
2.9 Strengthening ART logistics management ........................................................................................................................................................28
Images of various services / activities supported by STAR-EC................................................................................................................................29
3.0 Strengthening networks and referrals through community interventions to improve access to and coverage
and use of HIV and TB services................................................................................................................................................................................32
3.1 Community systems strengthening ...................................................................................................................................................................32
3.2 Support to strategic information collection and dissemination.........................................................................................................................35
3.3 Collaboration with strengthening Decentralization for Sustainability (SDS) program in the implementation of district-led activities...........36
3.4 Grants to civil society organizations (CSOs).......................................................................................................................................................37
4.0 Conclusion...........................................................................................................................................................................................................37
Appendices...............................................................................................................................................................................................................38
Appendix 1: Baseline TB/HIV Quality Improvement indicator dashboard................................................................................................................38
Appendix 2: Linkage of HIV+ clients to care : PY6, Q1.............................................................................................................................................42
April - July 2014 | i

Program Year 6
List of Boxes
Text Box 1: Key outstanding challenges in East Central Uganda.............................................................................................................................1
Text Box 2: Summary of key Option B+ activities during Q3 PY6;............................................................................................................................4
Text Box 3: Packages of services promoted during Q3 within combination prevention .........................................................................................9
Text Box 4: PHDP included: ......................................................................................................................................................................................17
Text Box 5: Key treatment achievements of Q3........................................................................................................................................................20
Text Box 6: Strategies that increased pediatric enrollment into care and on ART..................................................................................................21
Text Box 7: Key strategies for improving case notification rate (CNR)....................................................................................................................21
Text Box 8: Strategies to improve treatment outcome.............................................................................................................................................22
Text Box 9: Outline of support and laboratory key interventions implemented in Q3 PY6 for health systems strengthening................................24
List of Figures
Figure 1: Couple counseling and testing outcomes by various HTC interventions QTR3 PY6 (n = 40,033 individuals or 19,752 couple units)......2
Figure 2: HIV positivity by district QTR 3 PY6 (excluding pregnant and lactating women and their partners)........................................................3
Figure 3: HIV positivity by district for new ANC mothers during Q3 of PY6............................................................................................................5
Figure 4: PMTCT outcomes during QR 3...................................................................................................................................................................6
Figure 5: Comparative number of VMMCs conducted by district during Q3............................................................................................................8
Figure 6: Composition of key populations served (both new and old clients)..........................................................................................................10
Figure 7: Number of individuals reached through knowledge room-based services...............................................................................................11
Figure 8: Health concerns discussed with counselors through the hotline.............................................................................................................12
Figure 9: Progress on clients newly enrolled in care against quarterly target........................................................................................................14
Figure 10: TB diagnosis by ZN microscopy and GeneXpert machine from sputum specimens (Jan-Jun 2014) . ...................................................27
Figure 11: Performance of supported HC laboratories in TB NEQAS Q1-Q3 PY6....................................................................................................27
Figure 12: Stock status of ARVs and HIV test kits during Q3...................................................................................................................................28
02 | April - June 2014

List of Tables
Table 1: Summary of program achievements to-date...............................................................................................................................................07
Table 2: HTC (received results) outputs for Q3 by population group vs. PY6 quarterly targets...............................................................................2
Table 3: HTC cascade (using tested only) by type and strategy (excluding services received during PMTCT)........................................................3
Table 4: Comparative VMMC dashboard for sites that received an assessment visit during April-June 2014......................................................9
Table 5: Results for the continuum of response within combination HIV prevention among key and other vulnerable populations.....................9
Table 6: Number of sex workers reached with HIV-prevention services during Q3.................................................................................................10
Table 7: Combination prevention outcomes during island outreaches....................................................................................................................11
Table 8: Continuum of care for new PLHIV ..............................................................................................................................................................13
Table 9: Analysis of children less than 15 years active in care Q3, PY6..................................................................................................................15
Table 10: OVC reached with various services during Q3 PY6..................................................................................................................................16
Table 11: Results for key PHDP services disaggregated by gender and type..........................................................................................................17
Table 12: Number of clients newly initiated on ART by category: Q1-Q3................................................................................................................20
Table 13: Twelve months ART cohort analysis outcome- Quarters of PY6..............................................................................................................21
Table 14: District case notification rate for Q3 PY6.................................................................................................................................................22
Table 15: Treatment outcome for Q3 of PY6.............................................................................................................................................................22
Table 16: Achievements on select TB indicators for Q3 of PY6..............................................................................................................................23
Table 17: Laboratory diagnostic and monitoring outputs for TB and HIV & AIDS care in Q3 PY6 compared to Q1 & Q2 PY6...............................24
Table 18: Q3 PY6 laboratory outputs for other essential tests in Q2 compared to Q1 of PY6 . ..............................................................................25
Table 19: Q3 PY6 outputs of laboratory services provided to fisher folk during integrated clinical outreach.........................................................26
Table 20: Pregnant mothers mapped at community level during Q3........................................................................................................................32
Table 21: Referrals and services received during Q3...............................................................................................................................................33
Table 23: Results of performance validation exercises for STAR-EC-supported districts for PY6.........................................................................36
April - July 2014 | 03

Program Year 6
List of Acronyms
ABC Abstinence, being faithful and condoms DQA Data Quality Assessment
AIDS Acquired Immunodeficiency Syndrome DTLS District tuberculosis and leprosy supervisor
ANC Antenatal care EID Early infant diagnosis
ART Antiretroviral therapy eMTCT Elimination of mother-to-child transmission

of HIV
ARVs Antiretroviral drugs
FLEP Family Life Education Program
ASSIST Applying Science to Strengthen and
Improve Systems FC2 Female Condom
BIWIHI Bukooli Island Women Integrated Health FOC REV Friends of Christ Revival Ministries
Initiative
FP Family planning
BMU Beach Management Unit
FSG Family support group
CBOs Community based organizations
GLS Green Label Services
CD4 Cluster of differentiation 4
GoU Government of Uganda
CDD Community development department
HBHTC Homebased HIV testing and counseling
CDO Community development officer
HC Health center
CDFU Communication for Development Foundation
Uganda HIBRID HIV Based Real-time Integrated Database
CDR Case detection rate HIV Human immunodeficiency virus
CHAI Clinton Health Access Initiative HMIS Health management information systems
CNR Case notification rate HTC HIV testing and counseling
CoR Continuum of Response IEC Information, education, and communication
CPT Cotrimoxazole prophylaxis therapy JCRC Joint Clinical Research Centre
CPHL Central Public Health Laboratory JDHO Jinja Diocese Health Office
CSAs Community support agents JMS Joint Medical Stores
CSO Civil society organization JSI JSI Research & Training Institute, Inc.
DBTAs District based technical assistance partners LC Local council
DCDO District community development officer LMIS Logistics management information system
DHCs District health coordinators LQAS Lot quality assurance sampling
DHO District health officer LTFU Lost to follow up
DHT District health team MARPs Most-at-risk populations
DHIS2 District Health Information System 2 META Monitoring and Evaluation Technical
Assistance
DMC District management committee MC Male circumcision
DOP District operational plan MCPs Multiple concurrent partnerships
DOTS Directly observed short course

MDR Multi-drug resistant tuberculosis RTC Routine testing and counseling
MMS Medicines Management Supervisors SCORE Sustainable comprehensive responses for

vulnerable children
m2m Mothers2mothers
SCHW Sub county health workers
MoH Ministry of Health
SDS Strengthening Decentralization for
MTCT Mother-to-child transmission of HIV Sustainability program
NACS Nutritional assessment counseling and SIWAAO Sigulu Women AIDS Awareness
support Organization
NAADS National Agricultural Advisory Services SLMTA Strengthening laboratories management

toward accreditation
NAFOPHANU National Forum for People Living with
HIV&AIDS Networks in Uganda SOAR Strengthening outcomes, achieving results
NEQAS National external quality assurance SOPs Standard Operating Procedures
NMS National Medical Stores SPAI Service performance assessment and

improvement
NOP National OVC policy
SPARS Service performance assessment
NSPPI National Strategic Programme Plan of recognition strategy
intervention
STAR-E Strengthening TB and HIV&AIDS Responses
NTRL National Tuberculosis Reference Laboratory in Eastern Uganda
PACE Program for Accessible Health STAR-EC Strengthening TB and HIV&AIDS Responses
Communication and Education in East Central Uganda
PCR Polymerase chain reaction STIs Sexually transmitted infections
PEP Post-exposure prophylaxis SURE Securing Uganda’s Right to Essential

Medicines project
PEPFAR President’s Emergency Fund for AIDS Relief
TB Tuberculosis
PHDP Positive health, dignity and prevention
TSR Treatment success rate
PHFS Partnership for HIV free survival
UDHA Uganda Development and Health
PITC Provider-initiated testing and counseling Association
PLHIV Person living with HIV UHMG Uganda Health Marketing Group
PMTCT Prevention of mother-to-child transmission URHB Uganda Reproductive Health Bureau

of HIV
USAID United States Agency for International
PNC Postnatal care Development
PNFP Private not-for-profit USTP Uganda Stop TB Partnership
PROMIS PEPFAR Records and Organisation VEDCO Volunteer Efforts Development Concerns
Management Information System
VHTs Village health teams
PwP Prevention with Positives
VMMC Voluntary medical male circumcision
PY Program year
WAOS Web-based ARV ordering and reporting
QI Quality improvement system

Program Year 6
Executive Summary
This report details activities that were implemented by the Strengthening TB and HIV&AIDS Responses in East-Central Uganda (STAR-EC)
program during the period of April to June, 2014 of program year six (PY6). The report is being submitted in accordance with the provisions
of cooperative agreement number 617-A-00-09-00007-00 between USAID and JSI Research & Training Institute, Inc., the lead partner in the
implementation of the STAR-EC program.
The results presented in this report reflect the joint efforts made by STAR-EC, health facilities, civil society organizations, communities, the
private sector, and families in an endeavor to deliver a package of high-priority prevention, care and support, and treatment services focusing
on a ‘continuum of response.’
Over this reporting period, STAR-EC supported outreaches to most-at-risk populations (MARPs) and underserved populations and consolidated
HIV testing and counseling (HTC) activities in 118 facilities. A total of 286,448 individuals (130,957 males and 155,491 females, including those
tested in prevention of mother-to-child transmission (PMTCT) of HIV and voluntary medical male circumcision (VMMC) settings) received
HTC and test results. Cumulatively, this exceeded STAR-EC’s end-of-program (EOP) target by 11%. Of the 5,186 new individuals who tested
positive for HIV during HTC, VMMC, PMTCT, and other interventions, 94% and 67% were provided with cotrimoxazole and enrolled into care,
respectively.
During Q3, VMMC services were integrated into outreaches for other prevention interventions that prioritized areas with high HIV prevalence
and low male circumcision prevalence. The mobile outreach program started moving to Health Centres II. A total of 42,739 males were
circumcised and received other VMMC services at 22 static sites. This represents 132% achievement of STAR-EC’s third-quarter target
(which was 32,500 males).
Also during this quarter, STAR-EC continued to expand the evidence base for maternal and child health by supporting Option B+ for treating
HIV-positive mothers and protecting their babies from infection. A total of 38,855 pregnant and lactating women accessed HTC services
and received their results for PMTCT purposes (a 152% achievement of the project’s third-quarter target). Additionally, 1.4%, 1.1%, and 1.4%
women were diagnosed HIV-positive during ANC, labor and delivery, and PNC respectively. Overall, 909 HIV-positive pregnant and lactating
women accessed antiretroviral therapy (ART) during the quarter and of these, 564 were newly initiated on Option B+. Further, a total of 345
HIV-exposed babies were delivered at STAR-EC- supported health facilities; of these 289 (84%) were given prophylactic antiretroviral therapy.
Combination prevention approaches remained the mainstay of STAR-EC’s HIV-prevention responses, premised on the existing knowledge
of context-specific drivers of the epidemic in East Central Uganda. In an effort to address structural and behavioral drivers, health workers
teamed with peer educators and other linkage facilitators to conduct community dialogues, intensive risk reduction counseling, and link
clients with other relevant services. Condom education and distribution targeted MARPs, HIV-positive individuals, and other vulnerable
populations. A total of 2,510,901 condoms were distributed from 118 static and 1,839 mobile condom service outlets in communities.
Chronic care was supported in both facilities and communities and emphasized the engagement
of persons living with HIV (PLHIV) to help fellow clients access services and remain in care. Antiretroviral therapy (ART) services were
strengthened at the existing 95 health facilities, coupled with intensification of provision of CD4-count tests for more appropriate clients’
enrollment and clinical follow-up. Overall, 3,491 newly diagnosed PLHIV were enrolled in care during this reporting period, while 39,027
remained active in care (children active in care stood at 7.1%). Additionally, 6.4% was reported for children newly enrolled on pre-ART.
Dedicated teams consisting of linkage facilitators and health workers helped to rapidly enroll 3,120 new clients onto ART and strengthened
links between community volunteers and health facility staff in order to connect those clients to needed services.
Over this reporting period, STAR-EC maintained its support for activities that contribute to the achievement of the national TB indicators,
including improved case detection and treatment success rates and increased coverage of directly-observed treatment-short course (DOTS).
A total of 39,027 patients was reviewed during the quarter; of these 38,712 (99%) were screened for TB, and 141 of these patients were
identified with TB and started on treatment. The treatment success rate (TSR) for Q3 was at 84%, while the cure rate was at 66%, and loss-
to-follow-up 4%. Additionally, 98% of 502 TB patients were tested for HIV and 100% (153) of co-infected patients were enrolled on CPT and
132 (86.3%) were enrolled on ART.
Despite these impressive achievements, STAR-EC experienced a number of challenges. There were stockouts of HIV test kits, sulfuric acid
(needed for routine sputum microscopy for presumptive TB patients), CD4 reagents and cartridges for the point-of-care Pima machines.
STAR-EC will continue to work with its partners to address these challenges in Q4 and the remaining program life.

Table 1: Summary of program achievements to-date

Key Indicators PY1- PY5 PY6 outcomes End of Program Life
(Numbers)
Intervention area
Total PY5, (Oct Q1 Q2 Q3 sum of Q1 , PY6 % of PY6 End of Program % of PY6, Q3 comments( unless
achievements 2012 - Sept Q2 & Q3) Annual annual Program Cummulative End of specified)
(PY1-PY4) 2013) Targets targets Life Targets achievements Program
achieved to date (total Life
PY1*-Q2, Target
PY6) achieved
Individuals 1,097,755 817,011 155,477 218,832 286,448 660,757 781,100 85 2,317,295 2,575,523 111 Indicator measures overall
who received HTC services provided at
HTC and both static and outreach
their results sites including individuals,
(including couples, young people,
pregnant pregnant women, men who
women &PNC, received HTC during PMTCT
PMTCT partner and those served during
testing & VMMC post-natal care. 130,957 and
numbers) 155,491 were males and
females respectively.
Individuals who 855,307 667,687 120,972 187,847 241,345 550,164 679,100 81 1,815,875 2,073,158 114 HIV positivity rate
received was at 1.9%. A total
HTC and of 19,752 couple units
their results (40,033 individuals) were
(excluding counseled, tested and
pregnant received their results
women, PNC & together as a couple.
PMTCT partner
testing numbers)
Individuals 708 117 0 0 0 0 0 n/a 583 825 142 The program conducted
trained in HTC sufficient trainings in
its early stages which
facilitated meeting and
exceeding EOP life targets
for this indicator. Thus,
training of more HTC health
workers is not a program
HIV Testing and Counselling (HTC)
priority until a needs

assessment deems so.
However, on-job support
supervision of trained
workers will continue and
85 RCT volunteers were re-
oriented/given mentorship.
Outlets 123 static and 132 static 117static 118 static 118 118 static 148 80 148 132 static and 89 The supply of test kits and
providing 239 parishes and 385 and 190 and 294 static and 294 385 parishes other supplies continues to
T&C services (outreach parishes parishes parishes and 286 parishes (outreach be erratic
sites) (outreach (outreach (outreach parishes (outreach sites)
sites) sites) sites) (outreach sites)
sites)
Pregnant 280,418 140,475 30,616 27,571 38,855 97,042 102,000 95 501,420 517,935 103 32,469 women received HTC
women with and results during their first
known HIV ANC visit; 2,804 L&D and
status (includes 3,132 PNC with 1.4%, 1.1%
tested and and 1.4% diagnosed HIV
received results) positive respectively.450
including PNC had known and documented
HIV+ results. Erratic supply
of HIV test kits continues to
hamper implementation at
some health facilities
Pregnant 8,837 4,341 843 624 564 2,031 2,600 78 16,890 15,209 90 A total of 909 HIV positive
women who pregnant and lactating
received ARVs women accessed ART
to reduce during the quarter. These
the risk of included: 345 pregnant
mother to child women already on ART
transmission before 1st ANC
(new clients)
Persons trained 882 453 0 0 0 0 0 n/a 870 882 101 For Option B+
to provide implementation to be
PMTCT services successful, HWs from new
PMTCT sites have been
trained in previous quarters
while all personnel at old
sites have been oriented
as well.
Service outlets 245 118 110 108 110 109 118 92 118 118 100 However, only 93 of the
providing 110 sites offered Option B+
PMTCT
PMTCT services in Q3. The rest

offer referal services.
Targeted 487,561 316,003 105,224 78,978 89,998 274,200 286,000 96 903,000 1,077,764 119 Messages included taking
population an HIV test in accordance
reached with the risk profiles of such
with sexual individuals. In addition,
Sexual and Other Behavioral Risk Prevention (General
prevention 149,085 were old clients re-

messages visited more than once.
(general
pop+MARPs)
Individuals 1,096 162 0 0 0 0 0 n/a 1,060 1,258 119 Includes training of district
trained to condom focal persons,
provide sexual health educators and VHTs .
prevention
services
MARPs reached 68,702 70,473 32,419 34,571 33,831 100,821 64,400 157 198,900 239,996 121 29,981 of all MARPs were
with re-visited with additional
individual or information on combination
small group prevention during the same
level HIV program year.
prevention
based on
Population)
evidence and
meet minimum
required
standards

Program Year 6
Key Indicators PY1- PY5 PY6 outcomes End of Program Life

(Numbers)
Intervention area
Total PY5, (Oct Q1 Q2 Q3 sum of Q1 , PY6 % of PY6 End of Program % of PY6, Q3 comments( unless
achievements 2012 - Sept Q2 & Q3) Annual annual Program Cummulative End of specified)
(PY1-PY4) 2013) Targets targets Life Targets achievements Program
achieved to date (total Life
PY1*-Q2, Target
PY6) achieved
TB patients 5,942 2,024 464 587 502 1,553 2,000 78 8,100 9,519 118 Treatment success rate
who had an (TSR) for Q3 was at 84%
HIV test result while the cure rate was
Clinical/Preventive Services- Additional
recorded in the at 66% and loss to follow

TB register up at 4%.
HIV+ patients in 1,159 320 129 137 141 407 600 68 4,550 1,886 41
HIV care
or treatment
(pre-ART or
ART) who
started TB
treatment
Individuals 1,189 73 0 0 0 0 0 n/a 644 1,262 196
trained to
provide HIV/TB
TB/HIV
related palliative
care
HIV + individuals 24,335 34,517 35,475 37,346 39,027 39,027 68,000 57 74,250 39,027 53 More effort (as explained
(active clients) in the main report) will be
receiving a instituted during PY6 Q4 and
minimum of one PY7 to ensure enrolment of
clinical care newly identified HIV+ clients
service (CXT)… into care.
Cumulative
Adults and 12,339 8,657 1,473 2,641 3,120 7,234 20,770 35 50,365 28,230 56 End of program life
children with targets were increased
HIV infection in accordance with unmet
newly enrolled need estimated basing on
on ART eligible population. Scale
up strategies will include:
utilization of dedicated
teams to re-embark on
accelerating ART initiation;
outreaches, addressing
challenges on CD4 testing
and transportation of
samples as well as
Anti- Retroviral Therapy (ART)
strengthening referals
and linkages. Initiation of
Option B+ increased ART
enrolment
Adults and 12,278 20,577 21,449 23,574 25,937 25,937 47,707 54 52,900 25,937 49 Cumulative ART active
children with numbers have increased
HIV infection due to the introduction of
receiving ART Option B+ . However more
(CURRENT).. efforts as outlined in the
Cumulative main are needed in scale up
numbers to meet targets
Males 94,943 133,122 16,426 27,413 42,739 86,578 130,000 67 378,350 314,643 83 STAR-EC received
circumcised as received over 250 HIV test
part of Voluntary kits, 56,580 disposable
Male Medical circumcision kits and 4,500
Male Medical
Circumcision
Circumcision re-usable instrument pieces

Voluntary
through USAID’s central

(VMMC)
procurement system.
VMMC surgical 19 19 20 21 22 22 19 116 23 22 96
sites (static)
Local 11 9 3 8 8 8 8 100 11 11 100 During this quarter, eight
organizations CSOs were supported to
Health Systems Strengthening and
provided with TA start program and activity

for HIV-related implemention
institutional
capacity
building and SI
activities
Strategic Information
Individuals 379 93 0 0 63 63 0 n/a 383 383 100 All EOP targeted individuals
trained in SI have been trained. The
(including M&E, program is consolidating
surveillance these achievements through
and/or HMIS) on-going mentorship every
quarter. 63 LG personnel
were re-trained on LQAS
* PY1 (March-September 2009) involved only 3 months of actual implementation, the rest was program start-up activities
Source: STAR-EC program records

1.0 Introduction
1.1 Brief overview of STAR-EC
The STAR-EC program is implemented in nine districts of East Central Uganda, namely: Bugiri, Buyende, Iganga, Luuka, Kaliro, Kamuli,
Mayuge, Namayingo, and Namutumba. Currently, the region is inhabited by an estimated 3.1 million people; approximately 9% of Uganda’s
current population.
Since inception in 2009, the STAR-EC program has supported TB and HIV&AIDS services delivery in East Central Uganda under the following
objectives:
ff Increasing access to, coverage of, and utilization of quality comprehensive HIV&AIDS and TB prevention, care and treatment
services within district health facilities and their respective communities;
ff Strengthening decentralized HIV&AIDS and TB service delivery systems with emphasis on HCs IV and III and community
outreach;
ff Improving quality and efficiency of HIV&AIDS service delivery within health facilities and civil society organizations;
ff Strengthening networks and referral systems to improve access to, coverage of and utilization of HIV&AIDS and TB services;
and
ff Intensifying demand creation activities for HIV&AIDS and TB prevention, care and treatment services.
For a period of more than five years, STAR-EC has registered significant progress toward improving the scope, quality, geographical coverage,
and accessibility of HIV and AIDS and TB services in East Central Uganda using a health systems strengthening approach. Key services such
as HTC, PMTCT, and ART hitherto limited to hospitals, health center (HC)IVs, and a few HC IIIs, have been taken brought to people at more HC
IIIs, some key HC IIs, and within communities. VMMC services have since been introduced and are now delivered through 21 health facilities,
multiple outreaches, and circumcision camps. All public general hospitals in the region have been provided with CD4 count machines and
12 HC IVs and 7 HC IIIs have received point-of-care Pima CD4 machines from the Ministry of Health (MoH). Demand for services has been
created and both medical and lay service providers have been trained to provide quality services and conduct cross referrals between health
facilities and communities. However, there are still key outstanding challenges, as highlighted in Text Box 1 below.
Given these challenges, STAR-EC has, in PY6, embarked on a portfolio of key interventions to be delivered to target sub-populations.
Text Box 1: Key outstanding challenges in East Central Uganda

ff High HIV prevalence of 5.8% (the estimated number of PLHIV in the region in 2013 is 90,000 of whom only 35,475
(approximately 39%) are currently in care (by Q1, PY6)
ff HIV prevalence not uniform across the nine districts with lakeshore and island districts like Namayingo having a high
prevalence of 10.3% compared to 2.6% for Kaliro in PY3 High level of multiple concurrent sexual partnerships (MCPs)
estimated at 26% among men (UDHS 2011)
ff High prevalence of MARPs in the region (mostly fisher folk, commercial sex workers and truckers)
ff Though prevalence of circumcision in the region is estimated at 51%, additional data shows that 43% of adult males were
circumcised specifically for HIV/STI prevention purposes (LQAS 2013). VMMC need in the region is currently estimated at
190,000
ff Zonal TB reports for 2013 show TB case finding at only 34%

Program Year 6
2.0 Priority intervention areas during Quarter 3, PY6

2.1 HIV testing and counseling (HTC) Category of
population
Quarterly
target
Achievement Proportion
of quarterly
tested and achievements
received results
Pregnant 25,500 38,855 152%
and lactating
women
including
known and
documented
results
Male partners n/a 6,248
tested during
ANC
Overall 195,275 286,448 147%
Source: STAR-EC records
Figure 1: Couple counseling and testing

HIV testing and counseling services provision, Dolwe Island outcomes by various HTC interventions QTR3 PY6
June 2014
(n = 40,033 individuals or 19,752 couple units)
In delivering HTC services in East Central Uganda, STAR-EC worked
with a total of 118 health facilities: 100% of hospitals (4); 100% of
HCs III (59) and IV (12); and about 21% (43) of 204 HCs II; as well as
with subgrantees who reached out to the underserved communities.
The program continued to support 43 HCs II (10 located inland and

33 at island and lake shores of Mayuge and Namayin Districts)
and ‘hotspots’ such as Naluwerere, Idudi, Busowa, Kasokoso, and
Bulanga where HIV prevalence is the highest in the region. Table 2
highlights the HTC strategies employed during the quarter and their
outcomes vis-à-vis the PY6 quarter three targets. During Q3, a total
of 286,448 clients (130,957 males and 155,491 females) accessed HTC,
an achievement of 147% of the PY6 quarterly target of 195,275. The
program reached 71% of the quarterly target of 56,025 individuals
(served as couples).
Table 2: HTC (received results) outputs for Q3 by
Of the 19,752 couples, 262 (1.3%) were concordant positive and
population group vs. PY6 quarterly targets 127 (0.6%) were discordant. Figure 1 shows couple testing by the
various HTC interventions during the quarter. Table 3 illustrates the
Category of Quarterly Achievement Proportion
population target of quarterly HTC cascade by intervention. Integrated island outreach, community
tested and achievements peer HTC using model couples, moonlight HTC and provider-initiated
received results testing and counseling (PITC) at 113 health facilities yielded
General 81,250 154,543 190% proportionally more positives than any the other interventions, with
population VMMC posting the lowest positivity.
Couples 56,025 40,033 (19,752 71%
(individuals) couple units)
VMMC 32,500 41,324 127%
Female n/a 5,445
involvement in
VMMC

Table 3: HTC cascade (using tested only) by type and strategy (excluding services received during
PMTCT)
Nature of Type of outreach/static service (approach/ No. No. HIV+ HIV Ratio for detecting 1
activity implementation strategy) tested positivity HIV+ individual
Outreach Free-standing 53,032 1,052 2.0% 1:50
SMC 42,849 18 0.0% 1:2,381
Integrated couple week 35,301 519 1.5% 1:68
Community peer HTC (using model couples) 2,862 150 5.2% 1:19
Home-based HTC 15,108 337 2.2% 1:45
Moonlight HTC 328 12 3.7% 1:27
HBHTC/OVC 4,221 71 1.7% 1:59
Children care homes 2,144 40 1.9% 1:54
Integrated Island HTC 3,245 256 7.9% 1:13
Religious institution-based HTC 3,248 49 1.5% 1:66
Outreach Total 162,338 2,504 1.5% 1:65
Static PITC 75,210 2,044 2.7% 1:37
SMC 3,927 3 0.1% 1:1,309
Static Total 79,137 2,047 2.6% 1:39
Grand Total 241,475 4,551 1.9% 1:53
Least effective approach/implementation strategy in identifying HIV-positive individuals during quarter
Most effective approach/implementation strategy in identifying HIV-positive individuals during quarter
Source: STAR-EC records.
During the quarter, Namayingo and Mayuge posted HIV positivity rates higher than the quarter’s average (see Figure 2).
Figure 2: HIV positivity by district QTR 3 PY6 (excluding pregnant and lactating women and their
partners)

Program Year 6
2.1.2 Improving the linkage of newly diagnosed HIV- Way forward:

positive clients to care
During Quarter 4, STAR-EC will refocus its integrated HTC strategies
The program prioritized active referral and linkage of all clients further to target HIV burdened yet hard- to- reach key populations
diagnosed HIV-positive using the linkage facilitators at the facility with the intention of identifying more HIV positive MARPS, pregnant
and in the community. As such 5,186 HIV-positive persons identified women, and children, and others for the eventual active linkage into
during the quarter (including the general population, VMMC, couples, care and treatment.
male partners identified HIV-positive during PMTCT, and pregnant
and lactating women) excluding those with already known and 2.2 Virtual elimination of mother-to-
documented status were referred to care mainly through same-day child transmission (eMTCT) of HIV
active intra-facility linkage, with 94% and 67% successfully provided
with cotrimoxazole and enrolled into care, respectively. Text Box 2: Summary of key Option B+
activities during Q3 PY6;
Provision of technical assistance to the sites continued during the ff Supported provider-initiated testing and counseling
quarter, mainly through ongoing support supervision and on-the-job at ANC
mentoring; and logistical support where health facilities were given ff Operationalized ‘mother-baby’ care point concept
data tools and oriented on their use. Facilities were also assisted at ANC/MCH to ensure same-day appointments to
to order HIV test kits from National Medical Stores (NMS) timely minimize loss-to- followup.
and correctly. ff Supported linkage of HIV-positive pregnant women
and lactating mothers onto ART using linkage
Lessons learned: facilitators.
ff Targeted and high-impact integrated HIV testing and ff Supported provider-initiated family planning at high-
counseling services that are undertaken regularly have volume health facilities and lower level facilities
over time been associated with an apparent drop of HIV through outreaches.
positivity across the region, including the islands. ff Enhanced uptake of ANC, maternity, and postnatal
ff Community peer HTC using model couples targeting services at health facilities through community
spouses in discordant relationships, integrated island mapping and referral of pregnant and lactating
outreaches, moonlight HTC targeting truckers and women by VHTs.
commercial sex workers, and provider-initiated testing ff Used family support groups and Ariel children’s club
and counseling at health facilities were associated with meetings at health facilities and active client followup
a high HIV-positivity yield during the quarter. in the community to enhance adherence and retention
ff The dropping HIV positivity across the region means of mothers to Option B+.
that the program has to continuously rethink/adapt its ff Supported Option B+ logistics management by health
integrated HTC strategy to correctly target the high facilities according to MOH standards.
HIV burdened yet underserved and hard-to-reach key ff Supported improvement of option B+ enrollment,
populations in the hotspots. adherence and retention; and data completeness
through mentorships and on- job coaching.
Challenges: ff Operationalized Option B+ weekly reporting across all
ff During the integrated island outreaches, some people the 108 health facilities.
refuse same-day enrollment and linkage into care/ART
despite the best efforts of health workers, for reasons
including denial and preference of mainland ART sites,
which makes it difficlut to follow-up and ensure eventual
linkage.
ff HIV test kit supply from NMS has consistently been
outpaced by the demand despite the health facilities
ordering correctly and timely. As a result, HTC services
are predominantly undertaken at hospitals, HCs III and
IV, with the CSOs and HCs II struggling with persistent
stockouts.
A mentor mother facilitating a family support group meeting at

BIWIHI NGO HCII, Dolwe Island Namayingo District, June 2014.

2.2.1 Increasing availability, coverage of, access to, 2.2.1.2 Prong II: Prevention of unintended pregnancies among
women living with HIV
and utilization of eMTCT services
During the quarter, as a result of provider-initiated family planning
During the quarter, STAR-EC continued to support eMTCT
(FP) services at all Option B+ sites and integration of FP services
implementation at 108 sites in the region. Text Box 2 highlights key
provision during integrated outreaches in the community, a total of
Option B+ activities that the program supported during the quarter.
793 HIV- positive mothers accessed FP services, up from 710 in Q2.
Details of these activities are illustrated in this section in accordance
with WHO’s four-pronged approach to eMTCT.
2.2.1.3 Prong III: PMTCT among HIV-positive pregnant women
2.2.1.1 Prong I: Primary prevention of new infections in women
During Quarter 3, the program continued to support the 95 nationally
of child-bearing age
accredited Option B+ sites and 13 island and lakeshore HCs II on
During Q3 of PY6, a total of 38,855 pregnant and lactating women an outreach basis to offer PMTCT in accordance with the MOH
accessed HTC services during antenatal care (32,469), labor (2,804), guidelines. In this regard, STAR-EC supported the district health
and postnatal care (3,132). Of these 1,022 were HIV-positive, for a offices to offer PMTCT on-job mentorship and coaching to their
total of 910 HIV-positive pregnant women (new and known positive facilities, and a total of 909 HIV-positive pregnant and lactating
results) identified during ANC (compared to the quarterly target of women accessed ART during the quarter. These included: 345
650); 32 during labor and delivery, and 45 during postnatal. Another pregnant women already on ART before 1st ANC; 468 pregnant
450 women turned up with known and documented HIV-positive women initiated on Option B+ during ANC; 32 during labor and
results, an equivalent of 152% of the 25,500 PY6 quarterly target. delivery, and 64 during PNC. While the national target for pregnant
During the same period, a total of 5,976 pregnant and lactating women on Option B+ at ANC is 90%, STAR-EC was able to reach
women retested for HIV during ANC, labor and delivery, and 89.4% (813/909). In order to further minimize loss-to-followup due to
postnatal, with 0.6% diagnosed HIV-positive. Figure 3 illustrates the a mismatch in the ‘mother-baby’ pair, PMTCT-EID appointments the
HIV positivity by district for ANC mothers during Q3. The program program supported the operationalization of the ‘mother-baby’ care
continued supporting village health teams (VHTs) to identify newly point concept where the baby’s EID card is stapled to the mother’s
pregnant women and refer them to ANC services. Consequent to ART card and the two cards stored at the ANC/MCH until the baby
this effort, pregnant women counseled, tested, and received results graduates from EID. This has enabled same-day appointments for the
during ANC increased to 32,469 in Q3 from 22,353 in Q2, while the duo and drastically improved retention and adherence to Option B+.
positivity decreased to 1.4% from 1.8% during the same period. In a bid to improve the quality of reporting and use of data to focus on
During this quarter, the program facilitated national and district option B+ programming, STAR-EC supported the Ministry of Health
mentors to undertake Option B+ mentorship and coaching visits to 45 to roll out the Option B+ weekly reporting in the region. During the
high-volume health facilities with emphasis on data completeness, quarter the program was able to scale up the proportion of health
linkage of enrolled mothers into the pre-ART and ART registers, facilities reporting weekly from less than 50% in Q2 to more than 80%
adherence, and overall retention of the enrolled ‘mother-baby’ pairs in Q3. The challenge of getting the district health officers to own this
to Option B+ management schedule. reporting mechanism and hence motivate health workers to report
without reminders from STAR-EC remains. Figure 4 illustrates the
PMTCT cascade for the quarter.
Figure 3: HIV positivity by district for new ANC
mothers during Q3 of PY6
NAMAYINGO 3.7%
MAYUGE 2.1%
IGANGA 1.4%
OVERALL 1.4%
LUUKA 1.4%
KAMULI 1.3%
BUYENDE 1.2%
BUGIRI 1.2%
NAMUTUMBA 0.6%
KALIRO 0.6%
0.0% 1.0% 2.0% 3.0% 4.0%

Program Year 6
Figure 4: PMTCT outcomes during QR 3
2.2.1.4 Prong IV: Provision of care, treatment, and support to education and support to HIV-positive pregnant and breastfeeding
women living with HIV and their families women.
Key lessons learned:

ff Operationalization of the mother-baby care points at
all Option B+ health facilities in the region has not only
ensured same-day key EMTCT-EID appointments for the
mother and baby but also drastically minimized loss-to-
followup due to the reduced number of appointments.
ff Task shifting of non-clinical but complementary roles
of the health workers at MCH to lay health workers
has improved to access to key reproductive maternal,
neonatal, and child health (RMNCH) interventions.
ff Community mapping of pregnant and lactating mothers
by the VHTs has led to an increment in the uptake of
ANC, labor and delivery, and postnatal services in the
region.
A ‘mentor mother’ performs nutritional assessment (using Challenges:

mid-upper-arm circumference, MUAC) on a 15-month infant at
Busesa Health Centre. ff High PCR HIV-positivity test results in the region
primarily due to mother-baby pairs who did not attend
The program has continued to support intra-facility, inter-facility, and ANC or go through PMTCT at all and were diagnosed
facility-community PMTCT and early infant diagnosis (EID) links to post-natal.
ensure that all eligible mother-baby pairs are identified, enrolled, ff While the weekly Option B+ SMS reporting is quite
and retained on Option B+ (lifelong treatment). useful, the challenge that it is a vertical reporting
mechanism with minimal involvement of the DHO and the
biostatistician remains. District health officers need to
During this reporting period, the program continued to support the
own this reporting mechanism so that its sustainability
mentor mother model, where a total of 94 mentor mothers in 45
can be ensured.
PMTCT/ART sites oversaw early linkages, routine client education,
psychosocial support and individual client-centered sessions
Way forward:
targeting HIV-positive pregnant and lactating women, their partners,
and children (HIV exposed or infected babies) with the intention ff During the 4th Quarter, the program will focus its
of minimizing loss-to-followup while maximizing adherence and strategies on early identification, enrollment and
retention on Option B+ for the mother-baby pair. The program also retention of HIV-positive ANC pregnant and lactating
mothers in Option B+ during ANC. Having registered
enhanced the technical capacity of mentor mothers to support task
an increased uptake of ANC, maternity, and delivery
shifting for the integration of nutritional assessment counseling
services at facility level as a result of community
and support (NACS), TB screening, and provision of risk reduction

mapping by the VHT, the program plans to integrate

client followup and home-based HTC into mapping to
target pregnant and lactating mothers in high-positivity
subcounties and refer them to relevant services.
ff Using the male champions, mentor mothers, and expert
clients at Option B+ health facilities, mothers will be
encouraged in Quarter 4 to bring their spouses and
exposed babies to the FSG meetings so that exposed
babies not on prophylaxis are enrolled in EID and linked
to care if diagnosed HIV positive.
2.3 Voluntary medical male

circumcision (VMMC)
During Q3, VMMC services were scaled to 22 from 21 sites with
focus placed on districts that had low VMMC coverage in previous
quarters. A minimum package of services including HIV testing,
condom provision, STI screening and treatment, and promotion of
safer sexual practices has been offered to adolescent and adult 2.3.1 Scaling up VMMC while ensuring quality
active men. A total of seven high- volume sites were supported to
service
increase output at monthly week-long circumcision camps. This
quarter also saw increased vigilance on integration of VMMC
Quality assurance and improvement activities at VMMC sites during
into the monthly couple HTC campaigns and extended integrated Q3 were implemented in joint collaboration with the Applying Science
island service delivery visits. Sigulu, Bugaya, and Nawaikoke HC to Strengthen and Improve Systems (ASSIST). ASSIST provided in-
IIIs received fully constituted emergency kits resulting in a high-
depth support to Bugiri Hospital, Buyinja HC IV, and Nsinze HC IV,
level of preparedness to respond to potential emergencies at these and light support to Bumanya HC IV and Nankandulo HC IV while
new sites. STAR-EC received VMMC supplies and commodities from STAR-EC conducted assessments at Kityerera and Mayuge HCs
USAID’s central procurement system, including more than 250 HIV III (Table 4). STAR-EC also received supportive supervision from
test kits; 56,580 disposable circumcision kits; and more than 4,500 MOH in preparation for the passive phase of the prepex roll out
reusable instruments. in August 2014. STAR-EC printed MOH-approved VMMC reporting
tools for each of the supported sites. STAR-EC conducted quality
improvement coaching and mentorship visits to all supported sites.
STAR-EC-supported sites also received joint supportive supervision
from MOH and ASSIST to ensure adherence to national minimum
standards of procedure for VMMC services.
2.3.2 Scaling up VMMC while ensuring safe and

appropriate waste management
During Q3, the mobile outreach program started moving to Health
Centres II where space constraints negatively affect privacy,
aseptic conditions, cleanness, and safety. STAR-EC procured re-
modeled tents for each of the ten high-volume sites to mitigate these
problems. STAR-EC supported sites to continue on-site management
A client
A client receiving
receiving VMMC
VMMC services
services in East
in East Central
Central Uganda
Uganda of all waste generated during static and outreach VMMC activities.
Sites were supported to disinfect metallic waste from the disposable
During Q3, Uganda concluded the active monitoring phase for the kits and store them while awaiting guidance on final disposal from
prepex device roll out. STAR-EC participated by receiving minimal USAID. The strategy to store this waste onsite was aimed at avoiding
training at Makerere University Walter Reed Project (MUWRP) potentially harmful exposure by nonprofessional handlers. During
Mukono site in preparation for the passive monitoring phase that this quarter, STAR-EC received waste management materials
is scheduled to start during Q4. Bugiri Hospital and Busesa HC IV including 227 waste bins and 660 waste bin liners to aid in proper
have been selected for the prepex roll out in East Central Uganda waste management practices from USAID’s central procurement
and will be trained by staff from MUWRP. The Communication for system.
Healthy Communities (CHC) project is developing BCC/IEC materials
to create demand and will conduct regional and national education
campaigns for the media to market the device.

Program Year 6
2.3.3 Results
During Q3, 42,7391 adolescent and adult men were circumcised, surpassing the quarterly target of 32,500 clients. STAR-EC placed a lot of effort
on Namayingo and Buyende Districts where redeployment of teams from Bugiri Hospital and Bulesa HC III were heavily used to increase
outputs. All districts made tremendous increases in the number of clients served with VMMC services. Fast-tracking of approaches for rapid
acceleration of VMMC services that had been developed and agreed upon during the re-strategizing retreat in February 2014 contributed
to this achievement. Altogether, a total of 41,324 men were offered the opportunity to know their HIV status. Among the circumcised men
who received an HIV test, only 13 (0.03%) were found HIV positive and linked to HIV care at respective health facilities. In addition, a total
of 5,445 women (mostly partners accompanying males for circumcision) were tested and received their HIV results from a VMMC setting.
Only eight (0.1%) were positive. By reaching 42,739 men, the cost-benefit analyses2 point to having averted 2,249 new HIV infections thereby
contributing USD 2,249,000 to the national HIV-prevention effort. The aggregate Day 2 followup rate across the 22 sites increased to 90%,
while Day 7 followup averaged 62%.
Figure 5: Comparative number of VMMCs conducted by district during Q3
1 Includes 36 circumcisions done and not reported in January from Bugaya HC III, Buyende District
2 “Decision Makers Tool” developed by WHO and PEPFAR

Lessons learned
May
2014
2014
Infection prevention
Apr
100
93
ff Redeployment of VMMC teams to low-coverage areas
92
77
83
has greatly contributed to rapid achievement of results
2014
2014
as evident in Buyende and Namayingo.
Jan
Jan
100
100
100
92
75
Challenges and way forward
Sept
Sept
2013
2013
100
91
92
85
79
ff Metallic waste from disposable kits remains a big
Green ranges between 80%-100%

May challenge for sites since it is bulky and storage areas
2014
2014
Apr
are difficult to find at the facilities. STAR-EC awaits

86
86
86
64
83
resumption of Green Label Services (GLS), which has the
Monitoring &
technical capacity to handle this waste.

2014
2014
Jan
Jan
evaluation
86
93
67
71
71 ff Effective linkage into care of HIV-positive clients,

especially for those diagnosed at VMMC outreaches
Sept
Sept
2013
2013
since after getting their initial one-month course of

71
71
79
83
septrin, they seek care and treatment at facilities of their

choice.
May
2014
2014
Apr
100
100
surgical procedure
Male circumcision
94
Table 4: Comparative VMMC dashboard for sites that received an assessment visit during April-June 2014
2.4 Combination HIV prevention

2014
2014
Jan
Jan
100
100
100
Promoting sexual behavioral risk-reduction and

82
93
structural prevention within combination HIV

Sept
Sept
2013
2013
prevention
93
90
90
83
89
Text Box 3: Packages of services promoted

Individual counseling
May
2014
2014
Apr
100
100
100
83
83
during Q3 within combination prevention

& HIV testing
HTC, condom promotion and distribution, risk- reduction

2014
2014
Jan
Jan
100
100
100
89
83
counselling for BCC, psychosocial support services, STI screening

and treatment, linkages to ART, PMTCT, VMMC, eMTCT, & CD4.
Sept
Sept
2013
2013
83
89
94
83
During Q3, promotion of sexual and other behavioral risk prevention

May
2014
2014
focused on increasing individual risk perceptions to mitigate the

Apr
Registration group
67
83
84
83
67
education and IEC
dangers of transactional sex, multiple concurrent partnerships,

gender-based violence, early and forced marriages of young
2014
2014
Jan
Jan
100
Yellow ranges between 50%-79%
girls, cross-generational sex, and substance abuse (see Text Box

83
67
83
67
3 for summary of services package). Individual and small group

Sept
Sept
2013
2013
sessions dwelt on delaying sexual debut and secondary abstinence

100
67
83
67
67
among youth. Other activities included condom demonstrations,

enhancement of safer sex negotiation skills that were provided by
May
2014
2014
Supplies, equipment
Apr
83
83
84
67
67
health workers, CSO staff, VHTs, expert clients, and peer educators
& environment
with emphasis on providing linkages to biomedical HIV-prevention

2014
2014
Jan
Jan
services. Scenario events and condom karaokes were conducted

67
83
84
67
50
in known hotspots in the region while integrated community

outreaches, camps, and knowledge room-based services targeted
Sept
Sept
2013
2013
67
83
83
50
50
high-risk communities at landing sites, bodaboda stages, and on the

islands (Table 5 summarizes the outputs of these activities).
May
2014
2014
Apr
100
100
100
80
60
Table 5: Results for the continuum of response

Management
2014
2014
Jan
Jan
within combination HIV prevention among key

100
100
83
80
70
systems
and other vulnerable populations

Sept
Sept
2013
2013
100
90
90
80
90
Description of indicator Numbers reached

STAR-EC SITES
3 Kityerera HC IV
Number of individuals reached with 149,085 new and

3 Bugiri hospital
3 Mayuge HC III
2 Buyinja |HC IV
ASSIST SITES
1 Nsinze HC IV
risk-reduction messages 89,998 old clients
Number of condoms distributed 2,510,901 (95,251

Key:
female and 2,415,650

male condoms)

Program Year 6
Description of indicator
Individuals screened for STIs
Numbers reached
2,228
SUCCESS STORY
Individuals treated for STIs 1,318
Individuals who received family 2,024
planning services
2.4.1 Promotion of HIV prevention among key and

other vulnerable populations
Key populations (29,981 old and 33,831 new clients) including sex
workers and truckers (see Figure 6) were reached during Q3.
Other vulnerable populations reached by peers included 7,564 new
bodaboda transporters; 2,653 new plantation workers; and 58,524
young people.
Skills building session; a peer educator (donning a cap) mentors
a group of sex workers in Kandege (Sigulu islands) on proper and
Figure 6: Composition of key populations served consistent condom utilization use.
(both new and old clients)
During one of the sessions, Sara (not real name), one of the
youngest sex workers, shared her experience: “I did not know
that sex work was very hard and risky.” At the age of 17, life
was not easy for Sara because her parents could not afford to
buy essentials she needed for school. Sara recounted how a
cousin living in Lolwe-Kandege of Sigulu Islands told her that
sex work was an easy way for a girl to raise quick money to buy
personal effects. “I left school in pretence of sickness and made
it to Kandege for two weeks to make some quick money...Little
did I know it was very hard and risky,” recalled Sara. “ I did not
know how to use any condom (male or female) and I had not
mastered ‘shorts’ in sex work so I could not serve more than
one customer a day.” She is grateful because the skills building
sessions on safe sex and demonstrations on condom use have
been so beneficial to her. Because of these interventions, Sara
confidently said, “I am now able to protect myself but more
2.4.1.1 Efforts to reduce risk among sex workers importantly I have also realized the seriousness of the risk I was
taking. With encouragement from “basawo” I am planning to go
Sex workers were reached through mentor buddies, special STI back to school next year.”
clinics targeting hot spots, condom karaokes, and knowledge room-
based services including moonlight HTC.
2.4.1.2 Efforts to reach long-distance truck drivers with HIV-
prevention interventions
Health workers, peer educators, and VHTs worked hand-in-hand
during integrated special STIs clinics, island outreaches, and
Efforts to reach truckers were concentrated in the hot spots of
moonlight HTC to build skills on safer sex negotiation and condom
Naluwerere, Idudi, Musita, Magamaga, and Busowa–the busiest
use, and linked sex workers to other health services (see Table 6
truck stops in the region. Park yards, bars, and lodges as well as the
for outputs).
knowledge room are places where truckers have been reached with
messages of HIV prevention, condoms, and other BCC interventions
Table 6: Number of sex workers reached with (see Figure 6).
HIV-prevention services during Q3
Description of indicator Number reached

Number of sex workers reached with 1,302 new and 625
risk-reduction messages old clients
Number of condoms distributed 341,989

2.4.1.4 Promoting continuum of response within combination HIV

SUCCESS STORY prevention during islands integrated outreach camps
The islands of Mayuge and Namayingo were targeted with

the integrated outreach camp approach. Table 7 illustrates the
continuum of response at island outreaches during the quarter.
Table 7: Combination prevention outcomes during

island outreaches
Description of indicator Number
reached
Number of individuals reached with risk 50,134
reduction messages
Number of individuals tested for HIV 12,029
Moses shares the contribution of Naluwerere knowledge room
in reaching key populations Number of individuals tested HIV-positive 725
Enrolled into care and treatment 255
Moses Wakabi, the supervisor of the Naluwerere knowledge
Number of condoms distributed 309,157
room, sums up his experience in HIV-prevention among truckers
and sex workers. “I have a team of 10 peer educators who carry Number of individuals treated for STI 843
out community mobilization, interpersonal communication, and Individuals who were linked to family planning 283
linking clients. On a monthly basis, an average of 50 truckers, services
70 sex workers and 300 other persons at high-risk living in Source: STAR-EC program records
Naluwerere come to the knowledge room. Among the services
we provide are moonlight and daytime HCT, condom promotion 2.4.1.5 Promoting combination HIV-prevention among bodaboda
and distribution, general health education and peer support, STI transporters
clinic, and recreational facilities including board games, a pool
table, and digital satellite television.”
Figure 7: Number of individuals reached through

knowledge room-based services
Peer educator conducts a female education session at a

moonlight activation in Kasambira Kamuli District
Through bodaboda transporters association leadership, HIV-

Source: STAR-EC program records prevention campaigns were promoted within an integrated model
of service delivery that reached 7,564 new and 2,002 old bodaboda
2.4.1.3 Reaching fisher folk through integrated service delivery clients. The campaigns were in form of riding competitions and
approaches a quiz on basic HIV and AIDS facts. The bodaboda transporters
who came with their wives were attended to first. The quiz was
Combination HIV-prevention interventions targeting fisher folk meant to gauge the level of knowledge and risk perception on HIV
were delivered through integrated outreaches by the district health transmission to promote appropriate and factual information to
teams, resident island CSOs, beach management units, and VHTs meets the needs of this high-risk group. Health workers and VHTs
in the islands, and the knowledge room at Lugala landing site in offered other biomedical services including HTC, condom promotion
Namayingo. All HIV-positive fisher folk were linked to care and and distribution, ART, and linkage to SMC.
treatment services by the onsite linkage facilitators (VHTs and expert
clients).

Program Year 6
2.4.2 Utilising multi-pronged approaches to promote Efforts focused on providing information on specific behaviors
and attitudes like MCP, low condom use, early sexual debut,
condom use
transactional sex, cross-generational sex, and gender-based
violence to communities in need. To achieve this, STAR-EC
Beyond the static and mobile outlets of condom distribution, distinct
leveraged existing communication channels including community
condom promotion efforts took non-traditional multi-pronged
radio, video halls, street film viewing during community campaigns,
approaches including condom karaokes, education and distribution
and interpersonal communication through linkage facilitators and
during moonlight service delivery at recreational facilities such
influential individuals in the communities.
as bars, lodges, guest houses, and video halls. The BMU offices,
bodaboda transporters stages, and saloons are other strategic
During this quarter, the program aired 20 talk shows on five different
places that have condom dispensers to serve their clients. Peer
topics3 including low ANC and male involvement, positive prevention
educators attached to such outlets have provided interpersonal
and adherence, alcohol abuse, and community mobilization for a
communication and facilitated learning using pre-recorded visual
candle light commemorative event.
aids in the recreational condom outlets.
2.4.3.1 Utilizing technology to reach the general population with

Lessons learned
health messages
Working with the leadership of the different targeted and other
The toll-free hotline has continued to provide a bridging technology
vulnerable populations such as BMU, the bodaboda transporters
that connects people with pertinent health issues to online
association, and sex worker mentor buddies was instrumental in
professional counselors for one-on-one phone sessions. During
mobilizing constituencies for integrated HIV-prevention services.
this quarter, a total of 1,354 clients were served. Most callers had
concerns about family planning and VMMC. Issues raised included
The presence of the knowledge room-based services has opened
methods of family planning, myths, understanding how VMMC
a new front for reaching males who are less likely to seek HIV-
works for HIV prevention, healing process, and condom use after
prevention services in health facilities
circumcision. This innovation has helped people talk to counselors
because sessions are conducted without face-to-face contact. One
Challenges and way forward client said, “I had serious problems with my mother about my sex
life! My friends could not help because I could not share what was
Due to high STIs among sex workers and their clients, the project happening between me and my mother. I did not tell them anything
will continue conducting integrated approaches to service delivery but talking to anonymous counselor made me feel safe enough to
where STI management will be part of the package. open up.”
Younger female sex workers lack assertiveness and safer sex

negotiation skills. The project will continue working with mentor Figure 8: Health concerns discussed with
buddies to promote skills-building sessions to benefit younger and counselors through the hotline
new sex workers and will help them identify alternative sources of
income.
2.4.3 Promoting age- appropriate abstinence, be

faithful and condom use (ABC) strategies alongside
other biomedical HIV prevention in the general
population
3 EMTCT, community responses to HIV in children, HIV, alcohol, positive health dignity
and prevention, and candle light memory events.

A section of the youth viewing a health film in Busowa Trading
centre in Bugiri District during a night activation

2.4.3.2 Promoting combination HIV prevention for 2.5 Care and Support
couples
2.5.1 Clinical care
Married and cohabiting couples were reached through integrated
monthly couple week HTC, integrated outreaches to religious During this quarter, STAR-EC in collaboration with Ministry of
institutions, and community-based couple support programs. Health and one of the sub-grantees, Uganda Cares (AIDS Health
Emphasis was put on breaking the silence on marital issues. Couple Care Foundation-AHF), intensified knowledge and skill- building by
counseling and testing was found to simplify disclosure for both training health workers from HCs III and II whose sites were recently
discordant and concordant couples. Couples were linked to other accredited. A total of 90 health workers and 20 expert clients were
services such as SMC, family planning, ART, and psychosocial trained in integrated management of acute illnesses-antiretroviral
support for discordant couples. therapy and elimination of mother to child transmission ( IMAI-ART-
eMTCT) of HIV using the revised 13-day curriculum that combines
all HIV and AIDS care and treatment modules, and as expert patient
2.4.3.3 Promoting combination HIV prevention for youth
trainers (EPT) respectively.
A total of 58,524 new and 31,480 repeat-client young people were
The program continued to support integrated care and ART
reached with prevention interventions. Most out-of-school youth
outreaches to the islands of Jaguzi, Sagitti, Masolya, Bumba, and
were reached through community youth support programs during
Kaaza in Mayuge dDistrict and Sigulu, Dolwe, Yebe, Buduma, and
recreational activities such as sports and games. Peer educators
Bisa in Namayingo District. The continuum of care was reinforced
reached youth through interpersonal communication in one-on-
through linkage facilitators, direct escorting of newly tested HIV-
one and small group discussions that focused on building life skills,
positive individuals by lay counselors and phone reminders to clients
providing information on basic HIV and AIDS facts, delay of sexual
to meet their appointments. Additionally, 602 clients lost-to-followup
debut and secondary abstinence, and linking youth to services
(LTFU) were tracked through home visits using the National Forum for
including SMC, HTC, and reproductive health services. Youth who
People Living with HIV&AIDS Networks in Uganda (NAFOPHANU)
were HIV-positive were linked to psychosocial support services.
and community health workers. This combined effort resulted into
Youth were also reached through street film viewing, and plenary
retention into care of 59% (n = 65,610) of clients ever enrolled in
question and answer sessions.
HIV care. A closer look at previous program data showed a better
linkage of HIV- positive clients as compared to enrollment into care.
Lessons learned As a result, a new quality improvement strategy was adopted to
increase enrollment by triangulating registers to ensure that all
Integrating couple HTC during community-based couple support people tested positive are linked, enrolled, and receive pre-ART
programs enhances uptake of testing and counselling as well as numbers. Of 5,186 HIV-positive clients identified during the quarter,
disclosure of results. 3,491 (67%) were enrolled in care, an improvement compared to the
previous quarter (57%), as shown in Table 8. During this period, a
Livelihoods-support initiatives among already organized youth cumulative number of 38,748 clients (12,926 female and 25,822 male)
and couple groups have aided linkages to government-supported received cotrimoxazole.
programs like National Agricultural Advisory Services (NAADS).
Table 8: Continuum of care for new PLHIV

Indicator description for linkages Outputs during PY6
High STI among youth, coupled with poor parent-child Q1 Q2 Q3
communication and unfriendly youth services make it difficult
Proportion of newly identified HIV+ 69% 57% 67%
for young people to seek STIs services. The peer educators will clients from HTC who were enrolled
continue to counsel young people on the importance of delaying in care clinics
sexual debut and secondary abstinence and will provide referrals Proportion of new HIV+ pregnant 99% 85% 95%
and linkages to ease communication with health workers. women from ANC who were
enrolled in care clinics
Limited productivity due to high unemployment levels in the Proportion of new HIV+ infants from 41% 98% 52.2%
community leads young people to engage in risky behaviors such EID who were enrolled in care and
as substance abuse that expose them to the risk of HIV transmission. ART
Peer educators encourage young people to engage in healthy
activities such as sports and games.

Program Year 6
Figure 9: Progress on clients newly enrolled in care against quarterly target
2.5.1.1 Strengthening adherence and retention
Adherence support group meeting at Bwihi HC II, Dolwe Island
In effort to fight stigma and promote adherence and retention into care, the program collaborated with Uganda Cares to train 40 expert clients
on adherence support at Masaka Regional Referral Hospital. Furthermore, 22 sites were supported to hold twice-a-quarter adherence support
group (ASG) meetings where issues of ARV drug adherence and other challenges to retention were discussed. A total of 1,100 clients in
care attended these meetings.
In partnership with PACE, 2,932 clients were given basic care package (BCP) starter kits that include condoms and water guard tables.
Another 80,000 water guard tabs and 350 BCP were donated to the cholera outbreak in Mutumba Subcounty. The distribution of these kits
has increased retention and demand for the kits, especially in the island districts of Namayingo and Mayuge.

Challenges Challenge
ff The program is still grappling with adherence on the ff The region despite regular NMS deliveries has
island population because of their mobile nature. continued to suffer from inadequate test kits especially
ff Quarterly targets have not been met due to the erratic for HCs II and CSOs
supply of testing kits. Additionally, some people who test ff Low enrollment into care despite the various strategies
HIV-positive are not willing to enroll in care on the same used
day.
Way forward
Way forward
ff Designate pediatric lay counselors to specifically target
ff STAR-EC will train and mentor expert clients from island children at OPD and other service delivery points.
and mainland sites on adherence counseling, improving ff Strengthen outreaches while targeting dwelling places
documentation, practical measures of counseling, and of orphans and vulnerable children
ensuring same-day enrollment for all people who test
positive.
ff Harness integration of services like immunization
outreaches and national events like family days to
ff Strengthen integrated ART outreaches targeting MARPs, capture as many infected children as possible
especially the fishing communities on the islands of
Namayingo and Mayuge. 2.5.2.1 Strengthening OVC interventions
2.5.2 Pediatric care
Using the ‘know your epidemic, know your response’ approach, the
program focused on identifying the most-at-risk pediatric population
within the region. The initial phase was devoted to mapping of
key locations with high numbers of OVC. A total of 576 orphan
and vulnerable children (OVC) households and 6 OVC dwelling
places were identified in the districts of Luuka, Kaliro, Mayuge,
and Namayingo. Following the mapping exercise, 2,418 children
where counseled and tested registering a 1.3% (n=33) positivity.
These children were linked to various health facilities where they
were initiated on ART basing on the new treatment guidelines.
Additionally, HTC was provided targeting the pediatric population
in the islands of Dolwe and Sigulu in Namayingo District. As a result,
of the 960 children who tested, 9 tested positive and were newly
initiated on ART. Using the Early Infant Diagnosis-Central Public
Health Laboratory (EID-CPHL) data base, 88 children who tested Orientation
Orientation ofof policeofficers
police officersononOVC
OVCintegration
integrationininIganga
Iganga
positive with a dried blood spot (DBS) were followed up using
pediatric counselors and ‘mentor mothers’. Orientation of key stakeholders on OVC integration,
networking and linkages
During this reporting period, five facilities were supported to offer
During Q3, STAR-EC oriented 850 stakeholders from the nine
adolescent friendly services attracting both HIV negative and
districts in integrating OVC in their programming. The stakeholders
positive adolescents for specifically HTC, STI management and
included; the police, school nurses, civil society organizations,
psychosocial support. Of the 5,182 positive, 67% were linked and
VHT coordinators, expert clients and health workers. During the
initiated on ART; 1,691 were not linked because they had given a
orientation the stakeholders were taken through the OVC policy,
wrong address. Overall among all the new 3,491 clients served
the national strategic program plan of intervention, OVC quality
during the quarter, the program managed to link and enroll 224 (6.4%)
standards and OVC continuum of response and child protection
children into care - a finding short of the 15% national target.
issues especially defilement cases which appear to be on the
increase in the region. Stakeholders were advised to always refer
Table 9: Analysis of children less than 15 years defilement cases to the facility for examination, HTC and for PEP
active in care Q3, PY6 services.
PLHIV in care Q1 Output Q2 Output Q3 Output
Orientation of community stakeholders to case
management and child protection
Active in care 35,475 37,346 39,027
To strengthen coordination of child protection efforts, early
case identification, and linkage of vulnerable children, 210 child
Proportion of children< protection committee (CPC) members from Namutumba, Kaliro,
15 years active in care 7.3% 7% 7.1%
Mayuge, Iganga, Bugiri, and Kamuli districts were oriented to
Source: STAR-EC Program Records

Program Year 6
case management and child protection. The teams constituted 2.5.2.2 Support to young positives psychosocial
local council leaders, teachers, VHTs, religious leaders, and other
support groups at community level
community members who care about children. Their mandate is to
ensure that cases of abuse to vulnerable children are immediately
addressed, appropriately referred, and followed. As such, 212 child-
related cases (36 school dropout, 10 early marriage, 57 neglect/
abandonment, 36 defilement, and 73 physical abuse/domestic
violence) have been recorded, assessed, followed, and resolved
by the CPC.
Increase OVC linkages to HTC services, care, and

other wrap-around services
During Quarter 3, various strategies were utilized to target and reach
orphans and other vulnerable children (OVC). With the help of locums
and community-based Bantwana integration interns, more children
were referred to the facility for health services.
Table 10: OVC reached with various services Mukoda Florence, Young Positive in Luuka district was happy to
during Q3 PY6 share with us her story. ‘ I started my salon this year and I am
helping other 5 young girls to learn how to do hair dressing’. I
Section Indicator description No. served in Q3 have also been able to get some money for my basic needs. I
thank STAR-EC for mentoring us.
# of OVC served with HTC
at the facility 2,686
During the quarter under review, 18 young positive PSS groups
# of OVC that were were followed and supported to meet and initiate income generating
positive 122
activities. In total, 520 young positives attended meetings and were
OVC # of HIV+ OVC enrolled 139 mentored in various skills including poultry rearing, horticulture,
in care
piggery, and crafts. As a result, 31 young positives in Wabulungu
Some OVC are
received at facilities Subcounty, Mayuge District are engaged in tomato growing; seven
with results from in hair dressing; six in catering services; two in crafts; and three in
other testing centers mechanics, and most have taken poultry to supplement household
and directly enrolled
without being tested income. During these meetings, issues such as adherence, safer
again, thus a higher sex, and reproductive health are discussed.
number enrolled
than tested
# of young positives
active in care 2,355
linked to facility PSS
groups 615
referred for other wrap-
around services 241
Proportion of OVC lost-
to-follow up from HIV
care who are linked back 44
Young positive group in Mayuge District

Lesson learned
Integration of OVC concerns at various levels is vital in addressing a wide range of OVC needs at community and facility level.
Challenges
ff Cases of physical abuse and neglect/abandonment of children remain high in communities. These include defilement and
early marriage and are detrimental to children’s health and increase their chances of HIV infection.
ff Though most young positives groups have managed to start livelihood schemes, sustainability is a big challenge due to lack
of capital to buy appropriate farm inputs. For instance, a group in Wabulungu Subcounty that is engaged in tomato growing
lacked money to buy a spraying pump and pesticides therefore their tomatoes started to rot.
ff Lengthy legal processes and high expenses involved in following up defilement and child abuse cases hinder progress and
success rates in case management.
Way forward
ff The program will continue making OVC integration at health facilities part of continuous medical education sessions to ensure
that concerned medical personnel embrace the need to protect children.
ff Continuous education and mentorship of caregivers on child development, rights, health, obligations, and parenting.
2.5.3 Promotion of positive health dignity and prevention services among people living with HIV
Text Box 4: PHDP included:

ff Condom education and distribution
ff Counseling on safer sex options
ff Supporting HIV-positive pregnant mothers to go for PMTCT
ff ART and adherence counseling
ff Disclosure counseling
ff Family planning
ff Nutrition and balanced diet
ff Water, hygiene, and sanitation
ff Livelihood and income generating activities
HIV-prevention interventions were promoted through integration of positive health dignity and prevention services among PLHIV. The positive
health dignity and prevention (PHDP) package that was delivered is summarized in Text Box 4. The program supported expert clients including
mentor mothers, community support agents (CSAs), health workers, and VHTs to conduct risk reduction and positive living counseling through
one-on-one and small group sessions among peer support groups including discordant couples, young positives, and other concordant
couples and individuals living with HIV.
Table 11: Results for key PHDP services disaggregated by gender and type
Old PLHIV New PLHIV
TOTAL TOTAL
Indicator Females Males Females Males
Number of PLHIV reached with a minimum
package of prevention with positive (PWP) 11,703 5,944 17,647 881 506 1,387
interventions at facility
Number of PLHIV who received HIV transmission risk reduction assessment & counseling (adopt safer sex; reduce number of
sexual partners; reduce/stop alcohol use)
Adopt safer sex 3,465 1,545 5,010 494 316 810
Reduce number of sexual partners 2,078 866 2,944 349 406 755
Reduce/stop alcohol use 393 422 815 146 104 250
Number of condoms picked up by PLHIV (dual protection) from HIV care/ART clinic dispenser, disaggregated by type of condom
Male condoms 161,578
Female condoms 5,918

Program Year 6
2.5.3.1 Supporting young positives to live positively and minimize transmission and reinfection
Young positives were supported to meet and share experience of living with HIV. Among key issues and fears that the young positives raised
were:
ff Stigma inflicted by rumors about their status makes them feel very bad.
ff Taking ARVS without food affects their adherence.
ff They find it hard to take ARVS when their parents don’t; this discourages them and makes them think of giving up.
ff Very young positives fail to take their treatment when their parents are not at home.
ff Those in school fear to take medicine because their friends will see them.
ff Rude health workers at the health facilities.
ff Disclosure among older young positives is a challenge since some are already engaging in intimate sex.
ff Fear of separation in relationships causes some youth to keep their status secret.
During these meetings, a total of 450 young positives were counseled on the issues and concerns that were raised.
2.5.3.2 Reducing risk of HIV transmission among discordant couples
During discordant couple meetings, efforts were made to integrate services including routine testing for the negative partner, condom
demonstrations, and family planning for couples wishing to have babies. Key concerns among discordant couples included:
ff Negative partners fear that they may contract the virus from their positive partners.
ff Fear that a condom may not provide protection. Such anxiety sometimes affects their relationships.
ff Coping with the positive test result is a lifelong fear since the positives routinely develop self-pity and bear blame of infidelity.
ff Fear of divorce routinely worries them.
An expert client conducts HTC with the negative partner (wife) A discordant couples in need of condom refills raise their hands for
as spouse (in blue) looks on more from the counselor in Kamuli District.
2.5.4 Support care

2.5.4.1 Strengthening NACS and PHFS
STAR-EC has partnered with MOH in an initiative referred to as the Partnership for HIV Free Survival (PHFS) to improve maternal and infant
care and nutritional support. As part of the PHFS initiative, a baseline assessment in 94 facilities across the 9 districts identified anthropometric
equipment, nutrition data tools, and needs for nutrition IEC materials. Through the support given to the district nutritionists, 1.7% (184 PLHIV)
were given therapeutic food from RECO industries. This followed nutrition assessment and counseling of 10,868 clients from Kamuli General
Hospital, Kidera HC IV, Kigandalo HC IV, Kiyunga HC IV, Nsinze HC IV, Bumanya HC IV, Buyinja HC IV, and Bugiri Hospital.
Challenge
ff Despite routine mentorship of health workers by the few district nutritionists, there is still a high demand for nutritional
services for both HIV-negative and positive clients.

Way forward Lessons learned

ff Health workers across the Option B+ sites to be trained ff Collaboration between facility health workers,
in NACS in in Q4 PY6. community health workers, and spiritual leaders is
ff Anthropometric equipment and nutrition registers to be essential for comprehensive psychosocial support.
procured in PY6 Q4 for the Option B+ sites.
Challenges
2.5.4.2 Pain reduction and end-of-life care ff The use of improvised double-door cupboards puts
morphine at risk of misuse.
A total of 36 clients received either morphine (30) or codeine (6)
ff Transfer of health workers trained in palliative care to
for pain relief following chronic pain assessment. Following the non-accredited sites leads to a lack of prescribers at the
Hospice Africa Uganda (HAU) modular training in 2010 and follow accredited sites.
up visits in 2012, a technical support and mentorship visit to track
ff The prescribers are using exercise books to prescribe to
the progress of the morphine prescribers and palliative care officers clients, making it difficult to follow prescriptions trends.
was conducted in four model facilities (Kiyunga HC, Iganga Hospital,
Bumanya HC, and Kamuli General Hospital in IV in Luuka, Iganga, Way forward
Kaliro and Kamuli districts respectively). The mentorship included
home visits to bed -bound clients and involved 17 palliative care ff Double-lock cupboards to be procured for the four
officers. model sites,
ff Regular continuous professional development (CPD)
sessions to be encouraged to equip the clinicians in the
accredited sites.
ff Program to print palliative care prescription books and
registers for better patient followup.
2.5.4.3 Post-exposure prophylaxis (PEP)
During this quarter, there has been widespread PEP advocacy

through meetings and media channels like weekly radio talk
shows targeting health workers, district stakeholders, police, child
protection teams, community development officers, OVC care givers
and the general population to intensify initiation of PEP in defilement
cases. As a result, 27 people were given PEP; 23 for rape and assault
(all females); three for occupational exposure (one male and two
females); and one male following other/non-occupation exposure.
Palliative care officer dispensing morphine to a client during
home visit Challenge
ff Unwarranted soliciting of funds by health workers to
examine defilement cases deters victims from assessing
PEP services in certain districts.
Way forward
ff STAR-EC to engage the district leadership in dialogue
with health workers to remind them of their obligation to
examine defilement cases without pay.
2.6 Antiretroviral therapy (ART)

During Q3, the STAR-EC program continued to provide technical
assistance to consolidate the delivery of a comprehensive care/
ART package at 95 health facilities and improve utilization of services
and linkages.
Home visiting a client in Iganga District

Program Year 6
Accelerated initiation of ART continued using dedicated teams

Text Box 5: Key treatment achievements of
from Uganda Cares that supported 15 selected ART sites. This
Q3 approach involved actively searching for, counseling, and same-
ff 57 health workers and 15 expert clients were trained
day enrollment of medically eligible clients. To augment this activity
in comprehensive HIV care and treatment IMAI
there were monthly visits to selected high-volume ART sites by a
ff 37 expert clients were trained in adherence team of experienced medical personnel from Uganda Cares that
counseling at Masaka Hospital.
offered technical support supervision and ensured that most or all
ff 40 health workers trained as trainers in preparation medically eligible clients were initiated on ART.
for roll out of new ART guidelines.
ff 3,120 PLHV were initiated on ART. Of these, 338 (11%)
were children < 15 years; 425 (14 %) were HIV+
Table 12: Number of clients newly initiated on
pregnant women and lactating mothers (Option B+); ART by category: Q1-Q3
and 2,357 (75%) were adults > 15 years. In addition,
Q1 Q2 Q3 Total PY6 % annual
132 (4%) were found co-infected with TB/HIV and annual target
started on ART. target achieved
ff Median CD4 for all ART naïve clients initiated on ART Adults 976 1,977 2,357 5,310 15,570 34
improved from 367 cells/ul in Q2 to 370 by the end of (above 15
Q3. years)
ff The cumulative number of clients ever started on
ART increased to 32,922. Of these, 25,937 were found
Children 72 262 338 672 2,600 26
active on ART. (under 15
ff Proportion of children found active on ART was 8.2% years)
(versus national target of 15%).
Pregnant 425 402 425 1,252 2,600 48

Key activities focused on strengthening the health women
system through: (Option
ff Building the capacity of clinical teams to offer B+)
comprehensive HIV care services through on-job
training and clinical mentorships.
Total 1,473 2,641 3,120 7,234 20,770 35
ff Facilitating improvements in the physical infrastructure
to provide a spacious patient waiting shade at Kityerera
HCIV in Mayuge District to supplement the congested Source: STAR-EC program records
HIV care clinic as per national guidance on TB infection
control. In addition, there was enhanced identification of eligible clients
ff Providing logistics including spring file folders, registers, using the chart review approach whereby all client charts are
HIV care/ART cards, referral books, and furniture screened and those found medically eligible or due for CD4 testing
(benches, tables and chairs for 40 newly accredited ART are tagged with a sticker. This activity was conducted at 10 selected
sites) to facilitate provision of comprehensive HIV care/ high-volume sites by an intern deployed by Restless Development,
ART services. a youth-led development agency.
ff Using the ‘decentralized care model’ clients were
transferred to lower health facilities. The capacity of the The launch and operationalization of six new hubs in the region
lower health cadres was built through mentorships and has helped to increase accessibility of CD4 services at a number
support supervision. Consequently, many PLHIV clients of health facilities as has significantly reduced turnaround time of
have been accessing services from health facilities that
results.
are nearer to their homes, resulting in an improvement
in retention.
2.6.2 Strategies to improve adherence to treatment
2.6.1 Approaches used to increase initiation of and retention of clients in care
medically eligible clients on ART
STAR-EC continued to support expert clients to provide adherence
Initiation on ART and service utilization by PLHIV has risen over counseling and psychosocial support, especially for clients newly
the past three quarters as seen in Table 12. This achievement was initiated on ART. In addition, the program allowed expert clients
largely attributable to monthly ART outreaches targeting MARPs on to participate in several clinic activities such as health education,
the islands of Mayuge and Namayingo Districts using the “test and triage, file retrieval and storage, and linking clients to several delivery
treat approach” based on the new WHO guidelines. Satellite ART points, thus improving the quality of ART services.
outreaches to lower health facilities on the mainland and lakeshores
were increased to twice a month.

Text Box 6: Strategies that increased Lessons learned

pediatric enrollment into care and on ART ff Contacting clients who miss appointments by phone
ff Active followup of all exposed children to initiate them and home visits improves adherence to treatment and
on ART. retention of clients in care/ART. This activity will be
ff Strengthening linkages between EID care points and conducted regularly by all supported ART/PMTCT sites.
the ART clinics.
ff Use of the revised MOH guidelines (initiating all HIV+ Challenges
children < 15 years on treatment irrespective of their ff Irregular transportation of CD4 samples from 49 health
CD4 cell count). facilities (whose ART clinic days don’t coincide with the
ff Targeted HTC to areas with a high yield of HIV+ hub sample transporter schedule) to the regional hubs
children, including children homes/dwellings, negatively effects the rate of client enrollment.
pediatric wards, and OPD clinics. ff Despite the technical support provided in supply chain
management, a number of health facilities still have
During Q3, the program partnered with subgrantee NAFOPHANU stockouts of some ARVs due to poor accuracy of
to contact clients who had missed appointments. Through phone submitted orders.
calls and home visits by expert clients, a total of 1,447 clients from
42 ART sites (4 hospitals, 12 HCIVs, and 26 high-volume HCIIIs) were Way forward
contacted. Data analysis that 501 (35%) clients returned to the clinic ff Scale up ART services in Q4 to close gap between
after being contacted; 592 clients had self-transferred to other health clients targeted/planned for initiation onto ART.
facilities/districts; 36 lacked transport and failed to come regularly
ff Scale up ART services to fishing communities and
for treatment; 67 had family problems (separated/divorced) and left “hotspots” on the mainland. The program will facilitate
the area; 128 were not found (had given wrong addresses or phones dedicated teams to carryout integrated week-long
were not available); and 123 clients were dead. This approach helped outreaches. Using the “test and treat” approach, all
to reduce the lost-to-followup (LTFU) status of clients from 15.3% clients found HIV positive will be initiated on ART
during Q2 to 14% in Q3 as seen in Table 13. The retention of clients irrespective of their clinical stage or CD4 cell count.
on ART based on twelve months cohort improved from 74% in Q2 to ff STAR-EC will work closely with MMS to ensure that
79% at the end of Q3. health workers pay special attention to accuracy when
ordering drugs.
Table 13: Twelve months ART cohort analysis ff Work closely with MOH to intensify the roll out of the
revised WHO guidelines (procure job aides and on-job
outcome- Quarters of PY6 training/mentorships of clinical teams at all supported
Cohort analysis Oct- Dec Jan- March Apr–Jun sites).
indicators 2014 (Q1) 2014 (Q2) 2014 (Q3)
No. % No. % No. % 2.7 Clinical/additional TB/HIV
2.7.1 Increasing TB case notification
Clients started on 1,649 1,911 3,261
ART 12 months ago
(net current cohort) Text Box 7: Key strategies for improving
Clients still active on 1,226 74 1429 75 2,581 79 case notification rate (CNR)
ART after 12 months ff Mentorship and screening for TB in HIV clinics
ART clients dead 38 2 46 2.4 41 1 ff Intensified TB case finding in high-prevalence
within 12 months subcounties.
Clients who stopped 5 1 5 0.3 5 0.2 ff TB campaign outreaches.
treatment ff Integrated outreaches to Masolya and Sigulu islands.
ART clients who 117 7 137 7.2 178 5 ff Mentorship on utilization of Gene x-Pert machine.
missed appointment ff Sample referrals for Gene x-pert technology at
within 12 months
Buyinja HC1V and Jinja regional referral hospitals.
ART clients LTFU 263 16 292 15.3 456 14
within 12 months In order to increase case notification of all forms of tuberculosis
Source: STAR-EC program records (TB) cases, the strategies outlined in Text Box 7 were supported
However, emphasis was placed on supporting health care providers
Despite the above efforts, client retention on ART is still below the to perform quality TB screening in HIV clinics and sample referrals
recommended <90%. This is attributed to the highly mobile nature of for Gene x-pert technology. The total number of samples referred
the fisher folks on the islands and clients who transfer to other health for Gene x-pert technology and yield is highlighted in the laboratory
facilities/districts without informing health workers. The program
will continue to work with the ASSIST project for technical support
on QI issues; and linkages to care and treatment, adherence, and
retention of clients on ART.

Program Year 6
section. Overall, 491 cases of all forms were notified during the
quarter, resulting into a case notification rate (CNR) of 59/100,000
compared to the national achievement of 136/100000 for 2013.
Table 14: District case notification rate for Q3 PY6

District No. of No. of new CNR/100,000
expected TB cases population
TB cases/ notified (all
quarter (all forms)
forms)
Bugiri 200 84 72
Buyende 123 17 24
Iganga 231 121 90 Health education talk at TB adherence support group meeting,
Kamuli 232 48 36 Bugiri General Hospital.
Kaliro 100 35 60
STAR-EC also supported mentorship for quality improvement during
Luuka 121 34 49 baseline data collection on key TB/HIV indicators at 82 facilities.
Mayuge 213 85 69 The performance of facilities is highlighted in the TB/HIV quality
improvement performance dashboard in Appendix 1. Though
Namayingo 109 32 50
improving, the performance of sputum followup at some facilities
Namutumba 101 35 60 is still below the required standard due to frequent stockout of TB
Overall 1430 491 59 reagents. During the quarter, seven districts reported a treatment
Source: STAR-EC progressive quarterly reports. success rate (TSR) above the national target of 83%, and seven
districts reported a cure rate above the national achievement of 40%
and Q2 achievement of 61%. Overall, the TSR and cure rate stands
2.7.2 Improving treatment outcome under the DOTS
at 84% and 66% respectively, whereas lost-to-follow up is 4%. The
strategy beach management units (BMU) have been targeted to support TB
control activities including tracking fisher folks started on treatment
Text Box 8: Strategies to improve in the districts of Namayingo and Buyende. Patients transferred
treatment outcome outside the zone whose treatment outcome is not established at
ff District-specific review meetings and register the zonal validation meeting continue to affect the performance of
triangulation. some districts in the region.
ff Subcounty health workers supported to deliver
medicines and sputum follow ups Table 15: Treatment outcome for Q3 of PY6
ff Health sub-district focal persons support supervision
to peripheral sites District No. Number Number No.
registered successfully cured lost to
ff Quarterly zonal review meeting treated (cure followup
(TSR ) rate) (%)
ff TB psychosocial support group meetings
Bugiri 57 41 (72%) 34 (60%) 2 (4%)
During Q3, STAR-EC continued to assist district-based TB prevention Buyende 17 12 (71%) 12 (71%) 2 (12%)
and control efforts to implement community-based directly-observed
Iganga 98 85 (87%) 79 (70%) 1 (1%)
treatment short course (CB-DOTS) of TB. The overall CB DOTS
coverage for all patients stands at 70%. The quality of TB case Kamuli 44 37 (84%) 28 (64%) 1 (2%)
management for the region has steadily improved as a result of Kaliro 21 19 (90%) 19 (90%) 0 (7%)
intensifying the strategies outlined in Text Box 8. In addition, the
Luuka 13 12 (92%) 10 (77%) 0 (0%)
program facilitated the first TB adherence psychosocial support
group meetings at two (Iganga and Bugiri Hospitals) high-volume Mayuge 44 39 (89%) 16 (36%) 4 (9%)
sites. The aims of the meetings were to provide supplementary Namayingo 46 39 (85%) 32 (70%) 5 (11%)
patient education missed during patients’ enrollment on treatment,
Namutumba 20 18 (90%) 8 (40%) 1 (5%)
and to empower TB patients to demand TB control services.
Overall 360 302 (84%) 238 20 (4%)
(66%)

2.7.3a Improving TB/HIV collaboration The program continues to support and mentor health care providers
in HIV clinics to offer high-quality TB screening. A total of 39,027
Dissemination of the revised TB/HIV policy guidelines, the Gene patients were reviewed during the quarter; of these 38,712 (99%)
X-pert algorithms, and additional TB infection control guidelines is were screened for TB and 141 were identified with TB and started
ongoing as is dissemination of the revised ART policy guidelines. on treatment.
In addition, meetings held at district level to review performance
were utilized to disseminate the guidelines. STAR-EC continues to 2.7.4 Management of multi-drug resistant (MDR) TB
collaborate with SDS in provision of TB/HIV services in six of the
nine STAR-EC-supported districts.
2.7.3b Improving TB/HIV integration at facilities

ART enrollment for TB/HIV patients continues to improve as a result
of physical referrals, mentorship targeting high-volume sites, and
consolidation of intra- and inter-facility referrals. Five districts had
100% of their TB/HIV patients enrolled on ART by the end of the
quarter. The overall ART enrollment stands at 86%, compared to 84%
achievement of Q2. The target is to reach 100% ART coverage for
all TB/HIV patients. However, patients referred outside the district
in the first two weeks before initiation on ART continue to affect the
performance since this information is not readily established and
documented in the registers.
Health workers at Nankoma HCIV support an MDR patient to the
injection room for treatment initiation
Table 16: Achievements on select TB indicators
for Q3 of PY6
New patients recorded in
New patients recorded in
New TB patients tested
patients started on ART

patients started on CPT
TB register who had an
TB/HIV co-infected
TB/HIV co-infected
HIV- positive
HIV test (%)
TB register
Indicator
(%)
(%)
Iganga 123 121 39 39 29

(98%) (100%) (75%)
Bugiri 86 79 22 22 18
(95%) (100%) (82%)
Kamuli 50. 50 10 10 10 Lab staff receiving and packaging sputum samples for routine
(100%) (100%) (100%) monthly cultures at Iganga MDR centre
Namutumba 35 35 8 8 8
(100%) (100%) (100%) A total of 20 MDR patients from Jinja and other STAR-EC-supported
Kaliro 35 35 9 9 9 districts have been enrolled at 14 followup facilities since the
(100%) (100%) (100%) treatment center was established at Iganga hospital in August 2013.
Mayuge 88 87 17 17 16 Three of these patients were enrolled during the quarter. Sixteen
(98%) (100%) (94%) patients have been enrolled in facility-based directly-observed
Buyende 18 18 3 3 3 treatment and four patients in home-based care. All the patients
(100%) (100%) (100%) were still treatment compliant at the end of the quarter.
Namayingo 32 32 26 26 26
(100%) (100%) (100%) Lessons learned
Luuka 34 34 19 19 13 ff Health care providers in HIV chronic care services
(100%) (100%) (68%)
need regular on-job support and mentorship in order to
Overall 502 492 153 153 132 provide quality TB screening and link to TB services.
(98%) (31%) (100%) (86%)
ff TB psychosocial group meetings allow patients to share
Source: STAR-EC program records treatment challenges and bridge patient information
gaps.

Program Year 6

ff Stockouts of sulfuric acid affected routine sputum microscopy for presumptive TB patients and followup during the quarter.
STAR-EC will continue to support facilities to place orders in time for timely supply from NMS.
ff Lack of awareness about the GeneXpert technology among health care providers continues to pose a challenge for sample
referrals from eligible patients. Sensitization of health workers about GeneXpert technology and diagnostic algorithms is
ongoing through mentorship and during district and zonal performance review meetings.
2.8 STRENGTHENING LABORATORY SERVICES DELIVERY

A robust laboratory system is a cornerstone of high-quality health care services because it provides information for diagnosis of diseases
and generates surveillance data for programming. STAR-EC continued to provide support (Text Box 9) for TB and HIV and AIDS diagnoses
and monitoring and management of other illnesses.
2.8.1 Laboratory services for diagnosis and monitoring of TB and HIV and AIDS
Text Box 9: Outline of support and laboratory key interventions implemented in Q3 PY6 for
health systems strengthening
ff Supported operationalization of six laboratory hubs in East Central Uganda geared at strengthening the national specimen
referral network. The support included but not limited to recruitment of Hub Sample Transporters, maintenance of the hub
motorcycles, and logistical support.
ff Strengthened processes for early infant diagnosis of HIV among exposed infants through referral of dry blood spots by
conducting mentorship and providing essential logistics.
ff Supported implementation of National External Quality Assurance Scheme (NEQAS) for TB microscopy TB and HIV serology
in collaboration with MOH National TB Reference Laboratory (NTRL) and Uganda Virus Research Institute/HIV Reference
Laboratory (UVRI/HRL) respectively.
ff Facilitated utilization of GeneXpert machine to diagnosis of TB and detection of MDR-TB.
ff Provided support for maintenance (service and repair) of laboratory equipment at 8 HCs. These included CD4 machines,
hematology, and clinical chemistry analyzers at three general hospitals and colorimeters at 5 HC IVs.
ff Collection and collation of laboratory performance data for DHIS2 reporting (Tables 17 & 18).
ff Extended laboratory diagnostic services for TB, HIV&AIDS and STIs to hard-to-reach communities in the Islands of Sigulu
on Lake Victoria in Namayingo District.
ff Supported implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA) program at 5 health
facility laboratories.
ff In collaboration with USAID-funded SCMS project, provided equipment and accessories to five laboratory hubs (Kidera,
Buyinja, & Bumanya HCs IV received automated clinical and chemistry analyzers; Iganga General Hospital received clinical
chemistry analyzer). User training and installation is schedule for Q4 PY6
During Q3 PY6, more HIV-DNA PCR (n=1,262) and CD4 cells count (n=10,424) tests for EID and ART monitoring (respectively) were performed
than in Q1 & Q2 PY6. The former resulted in more exposed infants (n=95) diagnosed HIV-positive than in each of the previous quarters (Table
17). This increase was attributed to the fully operational capacity of the six laboratory hubs in the region, which has made specimen referral
more effective and efficient. Despite irregular supplies of HIV test kits experienced in this quarter, more HIV antibody screening tests were
reported than were in Q1 & Q2 of PY6.
Table 17: Laboratory diagnostic and monitoring outputs for TB and HIV & AIDS care in Q3 PY6
compared to Q1 & Q2 PY6
Intervention area Laboratory support PY6 Quarterly Outputs PY6 cumulative
Q1 Q2 Q3 total
(Oct-Dec 2013) (Jan-Mar 2014) (Apr-Jun) 2014)
DNA PCR tests reported 1,145 1,100 1,262 3,507
Early infant
diagnosis of HIV % DNA PCR tests reported
among exposed 5.6% 4.8% 7.5% 6.0%
positive
infants in support
of PMTCT Infants diagnosed HIV 64 53 95 212
positive

Intervention area Laboratory support PY6 Quarterly Outputs PY6 cumulative

Q1 Q2 Q3 total
(Oct-Dec 2013) (Jan-Mar 2014) (Apr-Jun) 2014)
Sputum TB ZN microscopy 5,258 7,050 5,099 17,407
tests reported
TB diagnosis by % sputum ZN microscopy
microscopy 7.3% 7.6% 7.5% 7.5%
tests reported positive for TB
Number TB patients 464 373 298 1,135
diagnosed
ART, care, and CD4 tests performed 6,210 9,007 10,424 25,641
treatment
HIV testing for PMTCT,
HIV antibodies HTC, diagnosis, & quality 135,227 149,801 209,386 494,414
testing assurance
2.8.2 Laboratory services for other clinical diagnostic services

In addition to TB and HIV&AIDS care, laboratories at STAR-EC-supported HCs continued to provide other clinical diagnostic and monitoring
tests to the community. This is geared to strengthen the health care system, as performance data is reported to the DHIS2 database and used
in planning. Apart from white blood cell count (WBC), film comment, and pregnancy screening, there were generally more tests performed
during this quarter than in the previous two (Table 18). This demonstrates the increased uptake and utilization of laboratory services by
clinicians to manage patients.
Table 18: Q3 PY6 laboratory outputs for other essential tests in Q2 compared to Q1 of PY6
Categories of laboratory investigations Name of laboratory test PY6 Quarterly Outputs Cumulative PY6
Q1 Q2 Q3 Total
(Oct-Dec (Jan-Mar (Apr-Jun

2013) 2014) 2014)
Hb estimation 8,179 5,205 6,800 20,184
Hematology WBC count 1,255 1,272 1,467 3,994

Film comment 655 576 538 1,769
Blood grouping 2,884 2,783 3,096 8,763
Blood transfusion
Cross match 1,733 1,526 1,956 5,215
Malaria 126,378 128,886 152,245 40,7509
Parasitology Other Haemoparasites 2,056 1,998 1,976 6,030

Stool microscopy 1,805 1,666 2,462 5,933
Microbiology Urine microscopy 4,621 4,734 5,824 15,179

Syphilis testing (VDRL/RPR/ 1,662 1,323 6,636 9,621
TPHA)
Serology and Immunology
Hepatitis B 299 323 499 1,121
Pregnancy 3,738 5,228 5,129 1,4095
Source: STAR-EC program & MoH/CPHL records

Program Year 6
One-stop point in a makeshift laboratory providing both HIV screening and CD4 testing during
the integrated outreach in Sigulu Islands
2.8.3 Taking laboratory diagnostic services to fisher folk in hard-to-reach Sigulu Islands on Lake Victoria in
Namayingo District
During integrated clinical outreaches conducted in the hard-to-reach Islands of Sigulu, onsite provision of laboratory diagnostic and services
for TB, HIV and AIDS and STIs were provided. A makeshift laboratory was set up and all the basic tests were provided. For tests not available
onsite, namely HIV-DNA/PCR for EID, the dried blood spot (DBS) were referred to MOH Central Public Health Laboratory (CPHL). The outputs
are summarized in Table 19.
Table 19: Q3 PY6 outputs of laboratory services provided to fisher folk during integrated clinical
outreach
Laboratory tests/investigations Total number of individuals Remarks
tested
HIV antibodies screening 2,821 192 (6.8%) of individuals tested HIV positive
ZN sputum microscopy for TB diagnosis 147 8 (5.4%) tested positive for TB
Hb estimation (g/dl) 169
Sputum testing on GeneXpert machine for 31 9.7% tested positive for TB but none was an
MDR-TB among HIV-positive individuals MDR-TB case
CD4 testing for ART monitoring 517 175 (51%) of these individuals had CD4 ≤500/µl
DBS for exposed infants referred to MoH/CPHL 29 17 (59%) of the exposed whose DBS was
for HIV DNA PCR referred were females
Syphilis antibody screening 88 6 (6.9%) tested positive for syphilis
Total number of individuals served 3,802
Source: STAR-EC Program records
2.8.4 Supporting MDR-TB diagnosis among HIV-positive individuals by GeneXpert machine

MOH/NTLP recommends testing for TB by GeneXpert technology among HI- positive persons who test negative by routine ZN microscopy
methods and subsequent assessment for MDR-TB. STAR-EC strengthened utilization of the GeneXpert machine from Q2 PY6 (Jan-Mar 2014)
to Q3 PY6 (April-June 2014) by supporting referral of specimen from peripheral HCs to Buyinja HC IV Laboratory Hub. Review of data showed
that GeneXpert machine detected 21 (11%) TB cases compared to 7 (4%) detected by ZN microscopy method among the individuals tested
(n=193). Outputs are summarized in Figure 10 and demonstrate that use of the GeneXpert machine can detect more TB cases than the routine
ZN microscopy method. Based on these results, the program will emphasize use of the GeneXpert machine to improve the TB notification
rate among HIV-positive persons next quarter.

Figure 10: TB diagnosis by ZN microscopy and GeneXpert machine from sputum specimens (Jan-Jun
2014)
Source: Buyinja HC IV laboratory hub records
2.8.5 Implementation of TB National External Quality Assurance Schemes (NEQAS)

Implementation of external quality assurance (EQA) is a vital for evaluating ability of laboratory personnel to perform diagnostic protocols.
In Q3 PY6, STAR-EC in collaboration with MoH/NTRL continued to support NEQAS for TB proficiency testing, and an average score of 92.5%
was attained (Figure 11). The MoH/NTRL pass mark score for TB proficiency testing is normally 80%. Program data shows that the STAR-
EC-supported HC laboratories have performed consistently from Q1 to Q3 PY6 (Figure 11).
Figure 11: Performance of supported HC laboratories in TB NEQAS Q1-Q3 PY6
Lessons learned
ff The laboratory hub system has greatly improved specimen referral for DBS for EID, blood samples for CD4 testing and sputum
for MDR-TB screening. This has improved access for people in rural communities.
ff The GeneXpert machine detected more TB cases than the routine ZN microscopy methods. STAR-EC will therefore augment
efforts to increase referral of sputum samples from HIV-positive individuals who test TB-negative by microscopy to Buyinja HC
IV laboratory hub for testing on GeneXpert machine.

Program Year 6

ff There were irregular supplies of HIV test kits, GeneXpert machines, and CD4 cell count supplies from the national logistics
system.
ff Use of GeneXpert technology for TB diagnosis is a new concept that many health workers are not familiar with. As a result,
few patients who meet the criteria for TB testing on this machine are referred for the test. The program will in Q4 PY6 conduct
mentorships to enhance uptake and utilization of this service.
2.9 Strengthening ART logistics management

During this reporting period, STAR-EC supported the logistics management information system to improve the flow of the necessary
information. This entailed printing and distributing LMIS tools to health facilities.
With the help of the district biostasticians and HMIS focal persons, health facilities continued to order for ARVs from the national warehouses
through the web-based ordering system. Other supplies were also ordered through the usual NMS ordering system. A review of the April-May
2014 Web-Based ARV Ordering and Reporting System (WAOS) Bimonthly Report shows that over 90% of health facilities sent ARV bimonthly
orders and reports to NMS and timeliness for reporting has improved since the previous cycle.
In order to strengthen the element of proper waste management, STAR-EC distributed more than 200 waste bins and color-coded bin liners
to six CSOs and 104 health facilities. Before a VMMC site can become operational, an emergency kit must be in place in case of adverse
effects during or immediately after the procedure arise. Items for the emergency kits were procured and distributed to three new sites of
Bugaya HC III, Nawaikoke HC III, and Sigulu HC III.
STAR-EC has continued to provide supplies to CSOs to enable them to provide services to hard-to-reach and underserved communities.
During this reporting period, CSOs were provided with examination gloves, condoms, waste bins, and bin liners.
Facilities continued to be stocked out of test kits, ARVs, and TB drugs despite timely submission of bi-monthly orders to warehouses. Figure
12 shows that in the months of April until June (weeks 14-25 in the weekly Option B+ reporting), stockouts usually coincided with the times
when there was no delivery of supplies. Facilities must ensure that the recommended buffer stock be kept in facility stores to minimize
stockouts. Buffer stocks last about two months..
Figure 12: Stock status of ARVs and HIV test kits during Q3
Source: MOH Option B+ weekly reports
Insufficient internet and network coverage/connection in some districts is still big challenge for timely submission of web-based orders and
reports. Biostasticians are being encouraged to submit orders far in advance to avoid internet connectivity problems.
Lessons learned
ff At the time of drug ordering, the recommended buffer stock of supplies lasting for a minimum of two months should always be
kept at the facilities to avoid stockout before the scheduled time of delivery of supplies.
ff The continuous use of bulk SMS services and phone calls as reminders from STAR-EC ensures timely submission of orders to
the national warehouses.

Images of various services / activities supported by STAR-EC
A VHT uses a mega phone to mobilize

during a market day in Lugala landing site
A peer educator conducts a small group VHTs conduct home based HTC in Kigandalo – Mayuge district
session with sex workers in Sigulu
VHT conducts one on one condom A health worker offers care and treatment
education in Bwondha landing site to one of the client in Matolo landing site

Program Year 6
A mentor mother counsels a mother STAR–EC staff facilities a family support group in Kityerera HC IV
during PNC visit in Iganga hospital
A peer educator conducts a dialogue session Caption

with sex workers in Naluwere T/C – Bugiri
A peer educator enjoys the company of men in the A mentor mother conducts individual post
knowledge room during a social in door game HTC counseling during Sigulu outreach.

Health workers performs SMC Health workers offering family planning

during an outreach in Sigulu islands services to a mother in Singira Sigulu Islands
In purple, a ‘mentor buddy ‘ of sex workers in Sigulu A community member in Iganga picks out
island shares her experience with STAR-EC staff condom from an outlet in Iganga
Improved ART records management A peer educator offers ‘off the sexual network’
a case of Kamuli General Hospital to truckers at Naluwerere knowledge room

Program Year 6
3.0 Strengthening networks and referrals through

community interventions to improve access to and
coverage and use of HIV and TB services
3.1 Community systems strengthening
During this reporting period, community systems were strengthened through the engagement of people living with HIV and village health
teams to link all HIV-positive clients to care, follow up with lost clients. STAR-EC registered improved comprehensive health service delivery
along the continuum of care for people living with HIV and their families. This is largely attributable to the implementation of action points
agreed upon at the quarterly co-ordination meetings at facility and health subdistrict levels, such as working with community development
offices; targeting OVC households and index client homes; and networking to increase community-facility linkages. STAR-EC continued to use
the formal district OVC structures of district, subcounty community development offices, and PLHIV networks to link vulnerable households
in the nine supported districts to a range of health services.
3.1.1 Active engagement of village health teams (VHTs) in mobilizing community members to increase
access to HIV & TB services
During Quarter three, STAR-EC continued to work with VHTs to strengthen community linkages, follow pregnant mothers, ART clients, and
mother-baby pairs, and mobilize communities to utilize health services. This followed the capacity-building interventions that oriented VHTs
to community eMTCT, TB intensified case finding, and OVC case management. STAR-EC continued to support quarterly review meetings
with VHTs to discuss performance, challenges, and ways to improve implementation during the following quarter. As a result of these efforts
19,298 clients were referred by VHTs to health facilities and 15,627 received services. STAR-EC continued to support the island-based VHTs
to identify and link TB suspects to TB screening, which resulted in 129 TB suspects identified, 11 of whom were diagnosed TB sputum
positive in June 2014. In addition, the mapping exercise of pregnant mothers undertaken by the VHTs showed that 47.6% (n=7,247) had not
yet accessed ANC services. Table 20 summarizes.
Table 20: Pregnant mothers mapped at community level during Q3

Total pregnant 3rd No. of pregnant women
District 1st ANC 2nd ANC 4th ANC Never attended
women ANC referred during mapping
Bugiri 7,703 2,174 1,711 1,287 1,087 1,444 2,432
Buyende 4,954 1,686 1,208 889 648 523 2,584
Iganga 5,014 1,498 1,152 910 658 796 1,193
Kaliro 4,158 1,280 961 726 645 546 1,666
Kamuli 7,306 1,957 1,653 1,328 1,157 1,211 2,803
Luuka 2,883 914 692 527 423 327 798
Mayuge 2,920 893 665 604 387 371 907
Namayingo 5,477 1,656 1,178 891 634 1,118 1,164
Namutumba 4,098 970 909 764 544 911 1,667
Grand Total 44,513 13,028 10,129 7,926 6,183 7,247 15,214
Source: STAR-EC VHT registers
With support from STAR-EC, VHTs further mobilized themselves into economic empowerment groups to improve income-generation capacity
and ensure sustainability beyond the project. There are thirteen groups; six have registered as formal groups in their districts so they can
apply for grant funding.
3.1.2 Meaningful and greater PLHIV involvement in improving community health and promoting positive
health, dignity, and prevention
A core group of people living with HIV have formed “linkage facilitators” teams to support fellow PLHIV through health education sessions,
peer counseling, providing condoms, and guiding them through the continuum of care. During quarter three, STAR-EC continued to support

the linkage facilitators through NAFOPHANU. Monthly meetings were conducted to facilitate sharing of experiences, testimonies, challenges,
and solutions. Linkage facilitators were also supported to identify, track, and bring back into care clients who missed appointments. The
facilitators contacted 162 clients and returned 112 returned of them to care. Community linkage facilitators were also involved in palliative
care, adherence support, and home-based HIV counseling and testing. During the quarter, expert clients/linkage facilitators tested 10,846
clients through the HBHCT intervention. All 341 of those who were identified as HIV-positive (3% HIV positivity) were linked to care in nearby
health facilities.
“With STAR-EC support, we trained

people living with HIV in income-
generating activities. As a result,
Mayuge district has six empowered
groups earning a living through
small scale ventures. They have
started activities ranging from tomato
gardening, drama groups, chicken
rearing, piggery, bead making, orange
plantation, mat making, mushroom
growing, and a village saving and loan
association, which raised 2,000,000
Uganda shillings. I am proud of my
groups. I am happy that they have
been able to pay school fees for their
children and improve their status of
living.” -PLHIV coordinator, Mayuge
Mother talks with an expert client during a mother-baby pair followup.
To ensure ongoing motivation and sustainability of the linkage facilitators, STAR-EC continued to engage PLHIV in income-generating activities
through their psychosocial support groups. To date, 85 support groups are involved in income-generating activities.
During Q3, ANC, PMTCT, HTC, family planning, STIs, TB, and VMMC referrals continued to be priorities. Table 21 summarizes the outcomes
of clients referred by the VHT tor health and other wraparound services. The improvement since Q2 was due to the continued support for
networking and coordination activities between the districts, CSOs, and other partner service providers (e.g. SCORE, Plan International, Child
Fund) to complete the continuum of response.
Table 21: Referrals and services received during Q3

Service Total referred Services received % received services
HTC 18,951 10,616 56%
PMTCT 1,703 1,409 83%
HAART 2,306 1,847 80%
TB 1,356 6,942 512%
Treatment of other conditions 8,104 6,942 86%
STI 3,159 2,700 85%
Home-based care 488 488 100%
Food and nutrition 266 230 86%
Material support 77 83 108%
Education support 482 394 82%
Family planning 8,856 7,933 90%
Discordant couple services 395 358 91%

Program Year 6
Service Total referred Services received % received services

Legal support 89 29 33%
Income-generating activities 116 130 112%
Post-test clubs 931 97 10%
PLHIV group services 596 505 85%
Total 55,157 47,431 71
Source: STAR-EC program data
3.1.3 Improving intra-facility linkages

Following the engagement of the nine locum staff, STAR-EC during this quarter recorded positive results in intra-facility and client’s linkages.
Patient linkage and tracking along the continuum of care improved from 27% at the time of engagement of the locums (September 2013) to
84% June 2014. The locum staff collaborated with health workers, VHTs, expert clients, and community development officers to ensure clients’
tracking and access to services. As a result, 1,304 clients were tracked through intra-facility linkage and 478 linked back to the community
for wraparound and OVC services.
3.1.4 Scaling up youth-friendly services in East Central Uganda

STAR-EC leveraged existing stable adult and pediatric HIV clinics to improve services for HIV-positive youth. Five health facilities were
supported to improve appointment scheduling for youth clinics and provide specialized care to adolescents. Information, education, and
communication (IEC) materials about condom use, HTC, sexual and reproductive health, family planning, disengaging from sexual networks,
STIs, safe male circumcision, and nutrition were provided to the facilities for distribution on clinic days. Adolescents attending these clinics
have been linked to community youth programs including games, psychosocial support groups, and income-generating activities. The number
of youth registering for youth friendly services has increased to 60 for Kamuli General Hospital; 40 for Kigandalo HC IV; 20 for Buyinja HCIV;
61 for Kiyunga HCIV; and 80 for Iganga Hospital.
Youth during a sharing session at Kamuli General Hospital. Youth reading information about sexual networks
3.1.5 Strengthening quality improvement at community to improve client adherence and retention in care
During this quarter, STAR-EC in collaboration with the Applying Science to Strengthen and Improve Systems (ASSIST) program intensified its
work with community structures (PLHIV, VHT, and local councils) to promote quality improvement (QI) in community activities and enhance
adherence and retention of HIV-positive clients. Facility-based expert clients who are members of the QI teams were supported to generate
lists of clients scheduled for appointments and conducted reminder home visits. The VHTs and community support agents provided adherence
counseling, disclosure support, reminders for clinic appointments, and other services during followup visits. This has improved adherence and
retention indicators in the supported facilities over the 12 months as presented (Table 13). In collaboration with ASSIST, STAR-EC conducted a
one-day meeting with representatives of QI teams from Kamuli and Bugiri, and community QI mentors. They shared experiences and strategies
to improve client followup, retention, and adherence to treatment. An MoH recommendedmentorship group includes health workers (ART

in charges) and PLHIV coordinators from the respective districts. A 3.2.3 Strengthening District Health Information
community followup home visit guideline was also discussed and
System (DHIS) 2 and open Medical Records System
shared with QI teams.
(MRS)
3.1.6 Strengthening community-based strategic STAR-EC supported data management by distributing 10 new
information systems computers and 10 internet modems. Two of the computers were
given to neediest districts (Bugiri and Namutumba) to support
STAR-EC continued to support community structures to collect, DHIS2, and eight went to high-volume health facilities to support
document, report, and utilize data for planning purposes. During open MRS. In addition to the ten new computers installation, general
Q3, STAR-EC supported VHTs with HMIS tools (096, 097, 15A, and maintenance and repairs were made for 10 other computers at
15B) to enable them report to facilities and subsequently the national various health facilities.
HMIS. On a quarterly basis, STAR-EC engages HMIS focal persons
in the collection, entry, and analysis of VHT data which is then
3.2.4 Support to use of evidence-based planning
shared at district and national level. To date, VHT reporting is at
75%, up from less than 40% during PY 5. STAR-EC also supported and decisionmaking using lot quality assurance
quarterly VHT data triangulation meetings at a regional level at which sampling
representatives from all supported subcounties gathered and shared
data experience and status of district reporting. As part of annual program progress monitoring, STAR-EC assisted
Local government (LG) personnel in conducting the 2014 household-
3.2 Support to strategic information based survey using the lot quality assurance sampling (LQAS)
methodology. Results from this year’s survey will be used to prioritize
collection and dissemination STAR-EC interventions and implementation during the remaining part
of the program. At the same time, results will help in evaluating the
3.2.1 District-led performance reviews program’s end-of-life targets and achievements.
In a bid to promote ownership and sustainability, all nine district
As in the past, results will also be used by districts to guide their
local governments organized and conducted district performance
LG fiscal year work planning and budgeting processes. This year’s
review meetings with minimal technical assistance from STAR-
survey increased involvement and responsibilities allocated to LG
EC. During these disseminations, each of the local governments
personnel to foster sustainability. Further, preliminary information
discussed various technical area achievements, challenges, and
was analyzed by LG personnel for rapid utilization within their
lessons related to sub-district, district, regional, and national targets.
own districts. During the training held in May 2014, a total of 63
Participants identified best practices and developed quarterly
LG personnel were trained/re-trained in LQAS methodology with
district-owned action plans in response to the previous bi-annual
one participant from each district taking the lead as LQAS district
period’s challenges. These included new strategies for realizing
focal person. The USAID/SDS project was able to provide financial
their PY6 targets, improving the quality of services, and plans for
support to six STAR-EC districts in the execution of this activity. Final
consolidation of success and sustainability. In addition, the new
and detailed results will be ready for further utilization during Q4.
national TB guidelines were communicated to subdistrict health
workers for immediate adoption and utilization.
3.2.5 Key meetings and workshops held with other
3.2.2 Routine data collection, validation, and support partners
supervision STAR-EC participated in the EMTCT DQA in Kaberamaido which was
conducted by MEASURE Evaluation in conjunction with Ministry of
STAR-EC conducted routine data collection and validation in a
Health. Four districts (Kaberamaido, Rakai, Ntungamo, and Arua)
number of health facilities in the nine STAR-EC supported districts.
were sampled for this activity. All 15 facilities visited reported both
This activity involved spot checks on utilization of primary data tools;
HMIS 105 and addendum reports. Hard copies of different reports
availability of HMIS tools; the status of the current data systems; and
for the given period were available at health facilities and have been
quality of data reported into DHIS2/MOH and STAR-EC’s database
entered in DHIS2 by the biostatisticians. Some of the best practices
including MEEPP’s HYBRID. In addition, these field visits were aimed
found in these districts were noted for adoption by STAR-EC, but it
at improving data quality, timeliness, and system strengthening at
was found that timeliness in entering DHIS2 data was still lacking
LG-supported health facilities. Main targets included voluminous
in non-STAR-EC supported districts.
sites (hospitals, HCs IV and III) and hard-to-reach HCs II where HIV
care and PMTCT services have been scaled up.
Challenges
ff Due to high staff turn-over and continued transfer of
health workers within and across different LGs, medical
records officers in some facilities were not trained in
HMIS reporting tools and this creates a problem when
reporting.

Program Year 6
ff Some midwives are not working in harmony with records delivery of specimen samples to laboratories designated as hubs.
officers when making monthly reports, which leads to Consequently, funding for specimen transportation through the
incongruence and compromised quality in reporting. Category A grant was abolished and DBTAs were urged to support
the laboratory hubs to make them operational. Accordingly, STAR-EC
Way forward supported the recruitment process of the hubs’ motorcycle riders as
ff HMIS 105 and addendum reports will be filled well as planning for and meeting their monthly wages and service
simultaneously. It is our hope that MOH will speed the and repair costs for their motorcycles.
process of harmonizing both reporting forms into one to
avoid reporting inconsistencies. 3.3.3 Implementation of Category A grant-funded
ff STAR-EC will continue promoting the mother -baby pair activities
concept to help harmonize reporting between EMTCT
and EID clinics.
The districts consolidated their performance in the implementation,
ff STAR-EC will continue helping district biostatisticians reporting, monitoring, and evaluation of and accounting for funds
utilize spreadsheets to monitor timeliness of various disbursed by SDS. This was evidenced by timely implementation
health facilities during reporting. The process includes
of activities in consultation with the relevant DBTAs/IPs, and
stamping and filing hard copies and keeping soft copies
joint monitoring and evaluation of activities including integrated
of the same information.
support supervision activities; integrated outreaches; attendance
3.3 Collaboration with at extended district health management team meetings; and timely
submission of program reports and financial accountabilities to the
strengthening Decentralization for SDS program.
Sustainability (SDS) program in
3.3.4 Performance evaluation exercises
the implementation of district-led
activities Although at the time of compiling this report performance validation
exercises for the quarter under review had not yet been conducted
3.3.1 Implementation of district operational plans (planned for early August 2014), desk performance review
exercises were conducted for the six districts supported by SDS
In a bid to ensure more rational allocation and utilization of financial and STAR-EC in the East Central region. However, an analysis of
resources, coupled with the need to gradually pass responsibility the performance of the districts over the past three SDS quarters
to the districts to fund activities using district resources to promote (for SDS, the quarters are based on the government financial year
ownership and sustainability, USAID/SDS reduced funding for July-June) indicates good and stable performance over the quarters
‘Category A’ grants by 60%. This revision meant that the DBTAs/ as indicated in the table below. Bugiri District performed best while
IPs and the districts had to reduce the hitherto Category A-funded others registered slightly slackened performance compared to
activities to match the level of available funding. This necessitated Quarter 2. The reasons for reduced performance included some
identifying activities that could be funded by the districts, merged unreconciled accountabilities as well as lack of supporting program
with others, or left out completely. Accordingly, a national planning reports and other essential documentation. These and other gaps
and budgeting workshop was convened by SDS to determine will be addressed by the DBTAs and districts to ensure that by the
activities that could be funded within the reduced funding. While time of the performance validation exercises slated for early August,
the funding reduction was a positive step toward strengthening the districts register better performance than in Quarter three.
decentralization and sustainability, it posed some challenges to the
districts to find alternative ways of funding the activities previously Table 23: Results of performance validation
funded through the Category A granting mechanism. Despite the exercises for STAR-EC-supported districts for PY6
challenges, the districts and the DBTAS/IPs remained committed to
implementing the approved activities and were creative in merging DISTRICT Round 3 Round 3 Round 3
Quarter 1 Quarter 2 Quarter 3
some activities and identifying alternative funding for others. It
should also be noted that Category B grants were indefinitely Bugiri 57% 83% 87.2%
suspended from the SDS funding portfolio. Iganga 68% 85% 80.3%
Kaliro 55% 94% 82.5%
3.3.2 Funding of specimen transportation
Kamuli 32% 83% 80.8%
One of the key achievements during the quarter was the Mayuge 0% 83% 82.6%
operationalization of six laboratory hubs (Kamuli District Referral
Namutumba 50% 84% 80.1%
Hospital, Kidera HC IV, Bumanya HCIV, Iganga District Referral
Hospital, Bugiri Hospital, and Buyinja HC IV) in the East Central region. Source: STAR-EC & SDS program reports
This was after USAID supported the MOH strategy of establishing
laboratory hubs across the country to enhance the collection and

Efforts will also be made to finalize implementation of the activities 3.4.2 Support for district-led activities
planned for the quarter (compiling program reports and reconciling
outstanding financial accountabilities and ensuring submission to STAR-EC continued to support implementation of district-led
SDS). activities including provision of supplies and technical support to
health workers to implement HIV&AIDS and TB activities. In addition,
3.3.5 Management of activities after STAR-EC STAR-EC continued to provide financial support to health facilities
program phase-out in Buyende, Luuka, and Namayingo Districts, which are not funded
by SDS.
STAR-EC used the opportunity during the various meetings and other
events convened by SDS to communicate to the districts, SDS, and 3.4.3 Monitoring and supervision
other DBTAs of the impending program phase-out of the program.
The milestones of the phase put processes that have a bearing on The grants team conducted monitoring and review visits to all
other DBTA activities and the districts were outlined by the STAR- grantees and CSOs in the field to ensure that financial reporting
EC representative. SDS and other DBTAs were urged to find ways is done in a timely manner and that issues related to financial and
of absorbing and sustaining some of the activities funded through programmatic reporting are addressed and resolved promptly.
the SDS Category A grant funding mechanism. Key among such During the island outreach visit, BIWIHI, the CBO in Dolwe
activities are the integrated outreach activities of HCT, TB, ART, was further supported in finance management, reporting, and
and VMMC targeting truck stops and key populations at fish landing organization management.
sites and the islands of Sigulu.
More focused discussions about how to manage activities of DBTAs

that will soon phase out (especially the STARs- East, East-Central
4.0 Conclusion
and South West) will be held with SDS and USAID in the near
future to determine the most effective and appropriate strategies Quarter 3 witnessed concerted efforts from STAR-EC consortium
of managing such activities. members, MOH, districts, CSO partners, and community volunteers
as well as other stakeholders in ensuring improved access to
3.4 Grants to civil society high-quality and comprehensive TB/HIV services. As a result, the
approaches used in delivering services were dynamic, evidence-
organizations (CSOs) informed, and client-focused. Emphasis was placed on interventions
The eight CSOs continued service provision to HIV high-prevalence that prioritized key and other vulnerable populations, who experience
communities through outreaches, making and following referrals high burden of new HIV infections despite the multi-faceted
to ensure clients get services to achieve a continuum of response challenges they meet in accessing services. Efforts to improve
for key intervention areas. The CSOs participated in the district-led the efficiency and quality of services through performance review
quarterly integrated outreaches in Sigulu and Jaguzi islands. meetings, data quality audits, and application of national guidelines
and standards continued. STAR-EC still aims at consolidating
Overall, CSO performance continued to improve, with emphasis on achievements registered so far and will continue to explore ways to
MARPS and linkages for antenatal, family planning, eMTCT, ART, sustain good practices garnered over the years of STAR-EC’s work.
and OVC. The CSOs were engaged to focus on increasing support
to those intervention areas whose overall program targets were yet During the next reporting period, the program will continue to
to be met, while continuing other activities at a slower pace. There increase reach of eligible populations as concomitant efforts
was timely release of funds to CSOs and all have accounted for the are placed on further strengthening of health systems. STAR-EC
funds disbursed during the quarter. would like to pay tribute to persons living with HIV who continue
to participate in delivering services and the indefatigable members
Supply of HIV testing kits from health facilities that usually supply of village health teams who mobilize, follow pregnant mothers, ART
them has remained a challenge, and affects identification of clients, and mother-baby pairs while linking all clients to various
positives for linkage to care and treatment. health services.
We extend our thanks to all district–based, national, and international

3.4.1 Sub-awards partners for all the support extended to the program. We look forward
to your continued support for the remaining part of program life.
The four sub recipients, Bantwana, CDFU, m2m, and Uganda Cares,
continued to implement program activities in the field to ensure a
continuum of response. Engagement of locum staff from Batwana
and Uganda Cares to roll out OVC integration and support the
accelerated initiation of ART respectively, continued thorough the
quarter.

Program Year 6
Appendices
Appendix 1: Baseline TB/HIV Quality Improvement indicator dashboard
BASELINE TB/HIV QI data for EC

Documentation
management
Co-infection
assessment
notification
completion
Treatment
Response
Retention
Treament
TB Case
TB/HIV
Atleast 3 entry points
% Completed and all

Presumed TB cases
TB Rx Completion
Known HIV status

assessment done
Use of ICF forms
Cat 2 TB cases
Completeness
Health Facility
appointment
% Keeping
evaluated
evaluated
on ART
on CTX
2 Mon
5 Mon
8 Mon
Bugiri
Bugiri Hospital ND 41 32 19 67 29 58 100 100 88
Buwunga HC III ND NA 100 50 33 100 100 100 100 100 100
Nankoma HC IV ND 100 50 67 67 100 20 67 100 100 67
Bulidha HC III 75 NA 0 100 100 100 100 NA NA NA NA
Muterere HC III ND NA NA NA 100 100 100 100 NA NA NA
Mayuge HC III ND NA 67 0 100 100 100 NA NA NA NA
FASTLINE M C ND NA 55 20 NA 100 NA NA Patients from
PFP this facility
access ART from
Hospital, most
patients reffered
to other districts/
facilities
URHB Bugiri ND NA 100 NA 0 100 0 NA 100 100 100
Bulesa HC III ND 100 83 75 67 100 67 100 83 NA NA
Kayango HC III ND NA 0 0 13 67 13 NA 100 NA NA
Buluguyi HC III ND NA 75 100 67 100 50 100 100 100 100
Iwemba HC III ND 100 100 NA 100 100 100 100 100 NA NA
Nabukalu HC III ND 100 50 100 50 83 50 50 100 NA NA
Byende
Irundu HC111 ND ND 40 43 100 100 89 100 100 100
St. Matia ND NA 40 100 NA 67 100 50 100 100 100
Mulumba
Bugaya HIII NA 44 80 100 100 100 100 100 100
Buyende HCIII 100 100 0/1 100 100 100 100 100
Nkondo NA 100 67 100 93 100 100 100 100 100
Kidera 100 14 22 40 100 100 100 100 100 100
Namayingo
Buyinja HCIV ND 100 40 80 17 100 83 100 100 100 100
Mutumba HCIII ND NA 67 67 100 100 NA 100 100 100 100

Documentation
management
Co-infection
assessment
notification
completion
Treatment
Response
Retention
Treament
TB Case
TB/HIV
% Completed and all

Presumed TB cases
TB Rx Completion
Known HIV status

assessment done
Use of ICF forms
Cat 2 TB cases
Completeness
Health Facility
appointment
% Keeping
evaluated
evaluated
on ART
on CTX
2 Mon
5 Mon
8 Mon
Banda HCIII NA 100 100 100 100 100 100 100 100 80
Hukeseho NGO NA NA 100 100 100 100 100 NA NA NA
St. Matia NA 40 NA NA 100 100 100 NA NA NA
Mulumba NGO
Bumoli HCIII ND NA NA 0/1 0/1 100 100 100 NA NA NA
Busiro COG NGO ND ND ND ND ND ND ND ND ND ND ND ND
Mayuge
Baitambogwe III ND ND NA 29 50 20 80 80 20 100 100 100
Wabulungu ND ND NA 18 25 0 80 100 0 100 100 100
Magamaga ND ND NA 0/1 NA NA NA NA NA NA NA NA
barracks
Buwaiswa ND ND NA 94 0 57 100 100 57 100 100 100
Kigandalo HCIII ND ND NA 72 50 80 100 100 66 100 100 100
Kityerera HCIV ND ND NA 65 10 0 100 100 0 100 100 100
Malongo HCIII ND ND NA 100 33 44 77 78 44 100 100 100
Mayuge HCIII ND ND NA 100 11 22 40 40 0 100 100 100
Namutumba 100 100 100
Nsinze HCIV 33 ND NA 100 100 100 100 100 100 100 100 100
Nabisoigi HCIII ND 100 75 75 65 100 78 90 100 100 100
Ivukula HCIII ND 100 100 100 80 100 85 80 100 100 100
Magada HCIII NA 70 60 60 80 90 80 100 100 100 100
Namutumba ND NA 70 60 60 80 85 65 100 100 100
HCIII
Bulange ND NA 80 70 70 90 95 85 100 100 100
Luuka 100 100 100
Waibuga 100 100 100 50 100 100 50 50 100 100 100
Ikonia 100 ND 50 NA 100 70 100 100 100 100 20
Bukanga 40 ND 73 NA 67 83 67 67 100 100 100
Kiyunga 60 100 NA 86 100 100 100 100 100
Irongo 77 100 100 0 0 60 100 100 100 100 100
Bukova 100 N/A 100 100 100 100 100
Ikumbya 100 N/A 100 ND ND 100 100 100
Kaliro
Nawaikoke 100 N/A 71 100 91 100 100 100 100 100 100
Gadumire 89 N/A 100 N/D 100 100 100 100 100 N/A N/A

Program Year 6
Documentation
management
Co-infection
assessment
notification
completion
Treatment
Response
Retention
Treament
TB Case
TB/HIV
% Completed and all

Presumed TB cases
TB Rx Completion
Known HIV status

assessment done
Use of ICF forms
Cat 2 TB cases
Completeness
Health Facility
appointment
% Keeping
evaluated
evaluated
on ART
on CTX
2 Mon
5 Mon
8 Mon
Namwiwa ND N/A 67 0 N/D 100 N/D N/D 100 N/A N/A
Bumanya 84 33 100 50 100 100 100 100 100 100
Budini 100 N/A 100 100 75 100 100 100 100 N/A N/A
Namugongo N/D 100 100 100 100 100 100 100 100 100 100
Iganga 100 100 100 100 100 100 100
Iganga hosp 100 100 100 81 100 83 100 100 100
Namungalwe N/A 87 100 89 100 N/A N/A
Nawandala N/A 84 100 90 100 100 100
Bugono 93 100 92 100 100 100
Nambale N/A N/A 91 100 95 100 100 100
Busesa 97 100 83 100 100 100
Busowobi N/A N/A 88 100 87 N/A N/A N/A
Bulamagi N/A 82 100 83 100 100 100
Islamic medical N/A N/A 77 100 90 100 100 100
centre
Iganga 86 100 86 100 100 100
municiple
council
Ibulanku N/A N/A 89 100 82 N/A N/A N/A
Lubira N/A N/A N/A 78 100 89 N/A N/A N/A
Makuutu N/A N/A N/A 73 100 85 N/A N/A N/A
Busembatia N/A 95 100 93 N/A N/A N/A
Kamuliu 100 100 100
Nabirumba 67 100 N/D N/D N/D 50 N/D N/D 100 100 100
Balawoli 100 N/A ND 50 100 100 100 83 67 N/A N/A
Namasagali 100 N/A ND 50 100 100 100 83 67 N/A N/A
Butansi 100 100 100 100
Mbulamuti HCIII 100 67 57 ND ND 86 50 ND 100 100 100
Nankandulo 100 ND 45 ND 50 100 100 50 100 100 100
HCIV
Bupadhengo 58 ND ND ND ND 50 100 ND 100 NA NA
Lulyambuzi 100 NA NA 100 100 100 100 100 100 100 100
Bugulumbya 100 NA 67 100 100 100 100 100 100 100 100
Kamuli General 100 58 47 30 50 67 67 67 100 100 88
hospital

Documentation
management
Co-infection
assessment
notification
completion
Treatment
Response
Retention
Treament
TB Case
TB/HIV
% Completed and all

Presumed TB cases
TB Rx Completion
Known HIV status

assessment done
Use of ICF forms
Cat 2 TB cases
Completeness
Health Facility
appointment
% Keeping
evaluated
evaluated
on ART
on CTX
2 Mon
5 Mon
8 Mon
Kamuli Health 100 ND ND ND ND 100 ND ND ND ND ND
care
Kamuli mission 100 ND 33 40 100 100 100 100 100 100 100
hospital
Kitayunjwa HCIII 100 NA 50 100 ND 100 ND ND 100 NA NA
Bulopa HCIII 100 67 ND 100 ND ND ND ND 100 100 100
Namwendwa 100 NA 100 100 ND 100 ND ND 89 100 100
HCIV
N0 ICF forms
were seen but
Health facilities
have Presumed
Charts placed on
the walls
Key
Performance at required standard for that indicator

Performance > 60% but less required standard
Performance less that 60%
NA No eligible cases
ND No data/ Not assessed

Program Year 6
Appendix 2: Linkage of HIV+ clients to care : PY6, Q1
Total Regional
Type of linkage
COMMENTS
Namutumba
Namayingo
description
Indicator
Buyende
Mayuge
Iganga
Kamuli
Bugiri
Luuka
Kaliro
HIV + from HTC HIV + 392 234 487 137 551 165 548 598 114 3,226 The positives
and CTX CTX 340 231 389 137 538 165 535 548 108 2,991 include the new
positives at ANC,
% 87% 99% 80% 100% 98% 100% 98% 92% 95% 93% L&D, PNC and
General HTC
including VMMC but
excludes known &
documented status
since most of them
are already in care
HTC to care # newly 392 234 487 137 551 165 548 598 114 3,226 All HIV positives
identified except those
HIV-positive with a known and
individual documented status/
TB
# identified 273 185 354 146 464 120 321 243 122 2,228 All clients enrolled
PLHIV newly in pre- ART in Q1
enrolled in
care
Proportion of 70% 79% 73% 107% 84% 73% 59% 41% 107% 69%
HTC clients
linked
HTC only to # newly 339 189 377 117 445 131 483 554 95 2,730 These excludes
care (excluding identified positives from
women from HIV-positive ANC,PNC and L&D
PMTCT) individual
# identified 220 147 247 119 367 88 245 207 92 1,732 These exclude new
PLHIV newly care clients from
enrolled in ANC, PNC and L&D
care
Proportion of 65% 78% 66% 102% 82% 67% 51% 37% 97% 63%
HTC clients
linked
PMTCT to care # new HIV- 53 45 110 20 106 34 65 44 19 496 These include new
(including positive positives from ANC+
all pregnant pregnant & PNC+ L&D
women and PNC women
PNC but # HIV+ 53 38 107 27 97 32 76 36 30 496 These are ANC, PNC
excluding pregnant & and L&D. To note,
known & PNC women we used option B+
documented) enrolled in clients as proxy for
care PNC and L&D care
clients since they
don’t have codes in
pre- ART register
Proportion 100% 84% 97% 135% 92% 94% 117% 82% 158% 100% % > 100% could be
of PMTCT due to enrolment of
clients linked revisit ( old) HIV+
mothers into care
due to option B+

Total Regional
Type of linkage
COMMENTS
Namutumba
Namayingo
description
Indicator
Buyende
Mayuge
Iganga
Kamuli
Bugiri
Luuka
Kaliro
PMTCT to care # new HIV- 43 33 92 15 77 18 60 40 14 392 These include new
(excluding PNC positive positives at ANC
and known & pregnant but exclude PNC ,
documented) women L&D and Known &
Documented HIV
positives
# HIV+ 37 26 88 23 75 28 63 25 23 388 These are ANC
pregnant clients newly
women enrolled in Care
enrolled in
care
Proportion 86% 79% 96% 153% 97% 156% 105% 63% 164% 99% % > 100% could be
of pregnant due to enrolment of
women revisit ( old) HIV+
linked mothers into care
due to option B+
TB to care # newly 14 4 46 5 16 4 24 23 4 140
identified TB-
HIV positive
# TB-HIV 14 4 46 5 16 4 24 23 4 140
cases
enrolled in
HIV care
Proportion 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
of TB clients
linked
Care to ART # PLHIV in 182 211 297 107 279 67 156 180 113 1,592
care eligible
for ART
# 177 141 276 107 269 67 155 179 102 1,473
eligibleclients
newly started
ART
Proportion 97% 67% 93% 100% 96% 100% 99% 99% 90% 93%
of eligible
clients
initiated on
ART

STAR-EC Headquarters
Plot 10 Kiira Lane, Mpumudde Division, P.O Box 829, Jinja
Tel: +256 434 120225, +256 434 120 277, +256 332 260 182, +256 332 260 183, Fax: +256 434 120232
www.starecuganda.org
STAR-EC Kampala Liaison Office

Uganda Health Marketing Group Building, 2nd Floor
Plot 20-21/27-28, Martyrs Crescent, Ntinda, P.O.Box 40070, Nakawa, Uganda,
Tel: +256 414 222 864, +256 312 262 164

Strengthening TB and Hiv&Aids Responses in East-Central Uganda (Star-Ec)

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STRENGTHENING TB AND

THE REPUBLIC OF UGANDA

April - July 2014 | i

02 | April - June 2014

April - July 2014 | 03

ANC Antenatal care EID Early infant diagnosis

ART Antiretroviral therapy eMTCT Elimination of mother-to-child transmission

CDR Case detection rate HIV Human immunodeficiency virus

CNR Case notification rate HTC HIV testing and counseling

CoR Continuum of Response IEC Information, education, and communication

CPT Cotrimoxazole prophylaxis therapy JCRC Joint Clinical Research Centre

CSAs Community support agents JMS Joint Medical Stores

DBTAs District based technical assistance partners LC Local council

DHCs District health coordinators LQAS Lot quality assurance sampling

DHO District health officer LTFU Lost to follow up

DHT District health team MARPs Most-at-risk populations

04 | April - June 2014

MDR Multi-drug resistant tuberculosis RTC Routine testing and counseling

MMS Medicines Management Supervisors SCORE Sustainable comprehensive responses for

NAADS National Agricultural Advisory Services SLMTA Strengthening laboratories management

NEQAS National external quality assurance SOPs Standard Operating Procedures

NMS National Medical Stores SPAI Service performance assessment and

PCR Polymerase chain reaction STIs Sexually transmitted infections

PEP Post-exposure prophylaxis SURE Securing Uganda’s Right to Essential

PMTCT Prevention of mother-to-child transmission URHB Uganda Reproductive Health Bureau

PNFP Private not-for-profit USTP Uganda Stop TB Partnership

April - July 2014 | 05

06 | April - June 2014

Table 1: Summary of program achievements to-date

priority until a needs

PMTCT services in Q3. The rest

prevention 149,085 were old clients re-

April - July 2014 | 07

Key Indicators PY1- PY5 PY6 outcomes End of Program Life

recorded in the at 66% and loss to follow

Circumcision re-usable instrument pieces

through USAID’s central

provided with TA start program and activity

Source: STAR-EC program records

08 | April - June 2014

Text Box 1: Key outstanding challenges in East Central Uganda

April - July 2014 | 1

2.0 Priority intervention areas during Quarter 3, PY6

Figure 1: Couple counseling and testing

The program continued to support 43 HCs II (10 located inland and

2 | April - June 2014

Source: STAR-EC records

April - July 2014 | 3

2.1.2 Improving the linkage of newly diagnosed HIV- Way forward:

A mentor mother facilitating a family support group meeting at

4 | April - June 2014

Source: STAR-EC records

April - July 2014 | 5

Figure 4: PMTCT outcomes during QR 3

Source: STAR-EC records

Key lessons learned:

A ‘mentor mother’ performs nutritional assessment (using Challenges:

6 | April - June 2014

mapping by the VHT, the program plans to integrate

2.3 Voluntary medical male

2.3.2 Scaling up VMMC while ensuring safe and

April - July 2014 | 7

Figure 5: Comparative number of VMMCs conducted by district during Q3