This is a 5 year USAID funded project. The project was awarded in May 2010 to the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in partnership with, Uganda Health Marketing Group (UHMG) and Mayanja Memorial Hospital Foundation (MMHF). In this partnership, Elizabeth Glaser Pediatric AIDS Foundation EGPAF the prime partner is responsible for the overall leadership and management of the STAR-SW project and serves as the technical lead for HIV/AIDS care and treatment, PMTCT, and systems strengthening, implements TB-HIV integration, laboratory strengthening and facility-based HCT activities.

Uganda Health Marketing Group implements demand generation activities for HIV/AIDS and TB services in the community. Mayanja Memorial Hospital Foundation provides strategic connections to VHTs, CSOs, CBOs and other community-level groups and works with the clinical services team to support community HCT, CB-DOTS for TB and home-based care (HBC) activities and provides strategic linkages to civil society organizations (CSO).

Project Goal

To increase access to, coverage of, and utilization of quality comprehensive TB and HIV/AIDS prevention, care and treatment services within district health facilities and their respective communities in 13 districts of South Western Uganda.

Project Objectives/Result Areas

1. Increase uptake of comprehensive HIV/AIDs and TB services within 9 districts in South -West Uganda.
2. Strengthen decentralized service delivery systems for improved uptake of quality HIV/AIDS and TB services.
3. Strengthen decentralized service delivery systems for improved uptake of quality HIV/AIDS and TB services
4. Establish or strengthen linkages and referral systems within and between health facilities and communities

Project Coverage

The project covers thirteen districts of Kisoro, Kabale, Kanungu, Rukungiri, Ntungamo, Busheyi, Isingiro, Kiruhura, Ibanda. Sheema, Mitooma, Rubirizi and Buhweju

Program Achievements

i) Assessment of referrals was conducted at 10 ART Health facilities. The assessment aimed at establishing how referrals are being recorded and who actually refers patients for health care services. All the health facilities assessed did not have files to keep the referral forms, no body at the facility was responsible for referrals and information on number of patients referred was not incorporated to guide planning.

In order to improve facility based referrals, a facility based referral coordinating team was formed, files for keeping referral documents. It was recommended that seminars on referrals, linkages and networks should be conducted and communities must be mobilized to effect referrals.

ii) CMEs on referrals were conducted at 25 ART health facilities. More than 997 health workers (480 males and 517 females) were reached with information. Quarterly facility based mentorship sessions followed up the CMEs. The health workers are now more equipped with knowledge and skilled how to hand referrals and have utilized the data for their planning. Health workers from HCIII within the catchment areas of targeted health sub district also benefited. The facilities were also supported with job aids on referrals.

iii) A total of 1112 VHTs (510 males and 602 females) were oriented on the program focused referral package (for services including SMC, ANC, HCT, PMTCT, EID and TB). The VHTs were also oriented on VHT referral tools and distributed to them.

iv) A total of 4165 clients were referred to health facilities for services including ANC, HCT, SMC, delivery at the health units and TB services across the districts. The VHTs were given a range of services for which they could refer and their data then submitted to respective sub county health workers.

3.4.0 Lessons learnt, Innovations and Best Practices I. Involvement of health based referral coordinating team and the sub county health worker led into improved management of referrals their respective health facilities. The coordinating unit consists of the in-charge, PMTCT focal person, TB focal person, VHT focal person, laboratory technician, II. Planning using referral data has led to improvement on the required logistics and medical supplies and also planning to initiate community tailored interventions like instituting structures to support TB CDR and TSR through supporting VHT TB volunteers 3.5.0 Implementation related Challenges o There is limited linkage between community social support groups/organizations and health facilities as noted in the interviews conducted. All health workers interacted with during the assessment reported that their health facilities were not referring clients to community organizations/groups and VHTs for continuing social support. o The practice of health workers on providing feedback to the VHTs after attending to the patients through filling part B of the referral form is still wanting.