THE REPUBLIC OF UGANDA THE PRESIDENTIAL FAST TRACK INITIATIVE ON ENDING AIDS AS A PUBLIC HEALTH THREAT IN UGANDA BY 2030.

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1 THE REPUBLIC OF UGANDA THE PRESIDENTIAL FAST TRACK INITIATIVE ON ENDING AIDS AS A PUBLIC HEALTH THREAT IN UGANDA BY 2030 Year 1 Report H.E the President of Uganda with other dignitaries at the national launch of the PFTI UGANDA AIDS COMMISSION June 2018

2 UGANDA AIDS COMMISSION Plot 1-3 Salim Bay Road, P.O. Box 10779, Ntinda Kampala - Uganda Tel: uac@uac.go.ug / nadic@uac.go.ug Website:

3 Table of Contents ACRONYM LIST Background Achievements in the rst year of roll out the presidential fast track initiative Establishment of the coordination structures Engagement of leaders at national and sub national levels Engagements of MDAs on the Fast-Track Initiative Districts engagements and rolling out the Initiative Sensitization of AIDS Development Partners (ADPs) and other stakeholders Roll out of the strategy Achievements as per fast track initiative objectives Engaging men in HIV Prevention and close the tap on new infection Accelerate implementation of Test and Treat Consolidate progress on elimination of mother to child transmission of HIV nan erusnecial sustainability for HIV and AIDS response Ensure institutional effectiveness for a well-coordinated multi-sectoral response Implementation Priorities for year

4 ACRONYM LIST ACP AIDS Control Program ADPs AIDS Development Partners AIC AIDS Information Center AIDS Acquired Immune De ciency Syndrome ANC Antenatal Care ART Antiretroviral Therapy ARV Antiretroviral CSF Civil Society fund CSO Civil Society Organization DAC District AIDS Committee DHIS2 District Health Information Software, version 2 DP Directorate of Partnership DPRP Directorate of Policy Research and Programming DPSI Directorate of Strategic Information DQA Data Quality Assessment EID Early Infant Diagnosis EQA External Quality Assurance FSH Family Support Group GBV Gender-Based Violence HCII, III, IV Health Center Level II, III, IV HCT HIV Counseling and Testing HIV Human Immunode ciency Virus HMIS Health Management Information Systems 2

5 IP LMIS M&E MAAIF MARPS MoES MoFA MoFPED MOH MoIA MoJCA MoLG MOPS NASA NMS NPAP NSP NTLP PEPFAR PF PLHIV PMTCT PMTCT PrEP SBCC Implementing Partners Logistics Management Information System Monitoring and Evaluation Ministry of Agriculture Animal Industry & Fisheries Most at Risk Populations Ministry of Education and Sports Ministry of Foreign Affairs Ministry of Finance, Planning and Economic Development Ministry of Health Ministry of Internal Affairs Ministry of Justice and Constitutional Affairs Ministry of Local Government Ministry of Public Service National AIDS Spending Assessment National Medical Stores National Priority Action Plan National HIV/AIDS strategic Plan National Tuberculosis and Leprosy Program President s Emergency Plan for AIDS Relief Partnership fund People Living with HIV/AIDS Prevention of Mother to Child Transmission Prevention of Mother-to-Child Transmission Pre Exposure Prophylaxis Socio-Behavioral Change Communication 3

6 SCES SMC/VMMC SOP SRHR STI TA TBHIV TWG UAC UNAIDS UNFPA UPHIA USAID USG Self-Coordinating Entities Safe Male Circumcision Standard Operating Procedures Sexual and Reproductive Health Rights Sexually Transmitted Infections Technical Assistance Tuberculosis/HIV coinfection Technical Working Group Uganda AIDS Commission The Joint United Nations Programme on HIV/AIDS United nations population fund Uganda population and AIDS indicator Assessment United States Agency for International Development United States Government 4

7 Acknowledgement The Presidential First Track Initiative (PFTI) was a directive from His Excellence the President to respond to the persistent high level of the AIDS epidemic and low pace towards achievement of set targets. The roll out and successful implementation of the PFTI has received support from The Presidency and cabinet, Parliament, Ministries Departments and agencies, Development Partners, Implementing Partners, Local Governments, Civil Society Organizations, Media, Private Sector, Media, Religious and Cultural Leaders. This report narrates the processes, activities and results achieved over the last one year since the launch of the Presidential First Track Initiative. The report identi es some challenges encountered during implementation and priorities for the second year. The documented PFTI results will be used for advocacy, accountability and as a re ection to inform the phase two activities. The process of writing this report has been widely consultative involving multi-sectoral stakeholders including; PFTI TWG, National Steering Committee, Development Partners and Civil Society representatives. I would like express my sincere and deep felt gratitude for the commitment and input from all the core writing team members (Annex 1) that included representatives from UNAIDS, UNFPA, UNWomen, IOM, UNICEF, CDC, MOH and the Uganda AIDS Commission. I urge all stakeholders to use this report to guide the implementation of future PFTI activities. Dr. Nelson Musoba Director General Uganda AIDS Commission 5

8 Executive Summary Introduction Over the years, Uganda has made progress in the ght against HIV and AIDS. New infections have reduced from 135,000 in 2010 to approximately 46,000 in HIV infections among children dropped from 26,000 in 2010 to 4,000 by the end of An estimated 1.32 million people are currently living with HIV. Of these, 1,084,689 are enrolled in care and 1,081,733 were on antiretroviral treatment by December Despite the progress made, the HIV burden remains unacceptably high and at the level of progress in 2016, it would not have been possible to meet the targets by 2020 and end AIDS as a public health threat by In March 2017, The President of the Republic of Uganda, His Excellency General Yoweri Kaguta Museveni, directed the Uganda AIDS Commission (UAC) to coordinate the Presidential Fast Track Initiative on Ending HIV and AIDS in Uganda by 2030 (PFTI). The overall goal of the PFTI is to achieve HIV epidemic control and eliminate AIDS as a public health threat in Uganda by Summary results To engage men in HIV Prevention and close the tap on new infections particularly among adolescent girls and young women, the following: During the year, the National HIV Prevention Committee (NPC) revised and aligned the HIV prevention road map to the Presidential FastTrack Initiative (PFTI). The road map outlines HIV Prevention and Management interventions/strategy, the implementation approaches that Uganda will priorities to end AIDS by

9 5000 leaders in over 93 districts have been engaged in implementation of the PFTI and over 15,000 copies of the PFTI message hand book distributed. The hand book is yet to be printed in the local languages. All districts and urban authorities adopted the Presidential Fast Track Initiative, signed the declaration to implement the PFTI strategies and developed action plans that are being implemented. Various districts are reporting discussing HIV issues in the council meetings. The Adolescent and young women inter-ministerial task force (chaired by the First Lady) developed a framework for addressing adolescent and young women issues, to guide all sectors on issues underlying their vulnerability to HIV. The First Lady launched the national sexuality framework intended to provide guidance to various actors reaching in and out of school children, adolescents and young people. The Ministry of Gender Labor and Social Development (MGLSD) nalized and launched the parenting guidelines. The MoGLSD nalized and launched a Gender Priority Action Plan that is currently being rolled out by the different partners The PIACSY program was reinvigorated and is being implemented in 42 districts under a USAID funded project School Reading Project. As a result of PFTI and other efforts for men to test, over 2,179,692 men (>15years) tested during 2017, with 69854(3.1%), identi ed as positive. And up to 82% of these are linked to care. 7

10 To accelerate Implementation of Test and Treat and attainment of the fast track targets particularly among men and young people: Uganda adopted and rolled out the consolidated HIV prevention and treatment guidelines that require all persons testing HIV positive to start ART treatment immediately. To consolidate progress on elimination of mother-to-childtransmission of HIV: Under the leadership of Her Excellency the First Lady, the country has registered major reduction in the number of new pediatric infection. Work is underway to assessment the country readiness for attainment of the WHO pre-elimination of Mother to Child transmission of HIV and Congenital syphilis. The Country has successfully integrated emtct services into routine RMNCAH in all HCIII and above. To ensure nancial sustainability for the HIV and AIDS response: UAC developed and rolled out the HIV and AIDS mainstreaming guidelines in the country. The guidelines are meant to ensure that all public and private institutions implement HIV&AIDS mainstreaming activities in a uniform manner, a set of minimum interventions have been developed to guide all sectors. UAC has worked with Parliament of Uganda, Ministry of Health and Partners to develop the ATF HIV prevention and control regulation. UAC working with Private Sector Self Coordinating Entity started the One Dollar initiative. The initiative is estimated to raise an average of about USD 10 million annually for the next 5 years. 8

11 To ensure institutional effectiveness for a well-coordinated multisectoral response: The Coordination of the multi-sectoral HIV response has been strengthened by appointment of the new UAC board and Director General. At National level, Parliament has been providing national HIV status reports in the plenary and at committee levels. The PFTI has been rolled out in 93 districts and all urban authorities. The districts and urban authorities have aligned their HIV plans (strategic & operational) to fast track the HIV response at sub national level. The national broadcasting association (media owners and practitioners) has committed to provide media space and coverage at discounted rates to increase community level knowledge about HIV. The President has continued to demonstrate leadership by mobilizing leaders at regional and global level through hosting high level meetings at African Union and UN general Assembly. The Uganda AIDS Commission and Ministry of Health, with support from Development Partners, nalized the Uganda Presidential Fast Track HIV situation room. The UAC in collaboration with the NGO registration Bureau at Ministry of Internal Affairs is developing standards to provide oversight for the assessment for registration and certi cation of AIDS services organizations to ensure alignment of their operations with the priorities in the NSP and the multi-sectoral AIDS response. 9

12 Priorities for year 2 The implementation of the PFTI in year one has generated substantive momentum and demonstrated positive results that will be consolidated in year 2. The priority areas for year two include: Strengthening the response at subnational level; Enhancing domestic nancing and increasing ef ciencies in programmes; Strengthening strategic information; and Streamlining coordination of partners and compliance to the NSP. 10

13 1. Background In March 2017, The President of the Republic of Uganda, His Excellency General Yoweri Kaguta Museveni, directed the Uganda AIDS Commission (UAC) to coordinate the Presidential Fast Track Initiative on Ending HIV and AIDS in Uganda by 2030 (PFTI): a 5- Point Plan. A national level Steering Committee, consisting of mainly Permanent Secretaries of Key Ministries, representatives of AIDS Development Partners, People Living with HIV and Special Interest groups, was constituted by the Minister for the Presidency to operationalize the PFTI. The National Steering Committee subsequently established the Technical Working Group (TWG) to provide day to day guidance for the implementation of the PFTI. The overall goal of the PFTI is to achieve HIV epidemic control and eliminate AIDS as a public health threat in Uganda by The Initiative aims to ensure nobody is left behind, and advocates for increased focus on proven effective interventions of the HIV response and addressing prevailing gaps in coverage of key services. The PFTI focuses on the ve point plan: 1. To engage men in HIV Prevention and close the tap on new infections particularly among adolescent girls and young women; 2. To accelerate Implementation of Test and Treat and attainment of the fast track targets particularly among men and young people; 3. To consolidate progress on elimination of mother-to-childtransmission of HIV; 4. To ensure nancial sustainability for the HIV and AIDS response; 5. To ensure institutional effectiveness for a well-coordinated multi-sectoral response. 11

14 State of the HIV Epidemic in Uganda Over the years, Uganda has made progress in the ght against HIV. New infections have reduced from 135,000 in 2010 to approximately 46,000 in New HIV infections among children dropped from 26,000 in 2010 to 4,000 by the end of An estimated 1.32 million people are living with HIV. Of these, 1,084,689 are enrolled in care and 1,081,733 are on antiretroviral treatment by December The Annual AIDS related deaths have reduced from about 100,000 in 2004 to 20,000 in In 2016 alone 14,348 men died of AIDS compared 9,600 women in the same year. Alignment of PFTI to existing national HIV strategies The PFTI is aligned with the National HIV and AIDS Strategic Plan (NSP 2015/ /20) and commits to fast track implementation of the interventions in the NSP. The Uganda AIDS Commission (UAC) coordinates the implementation of the PFTI within its mandate as directed by The President. UAC undertakes this assignment through strategic partnerships with Ministries, Departments and Agencies of Government, Civil Society, Cultural and Religious Institutions, the Private Sector, Media, Young People, People Living with HIV, Local Governments and Development Partners. A key strategy of the Initiative roll out involves a short-term leadership mobilization campaign to enhance short and medium term systematic focus on policy, programmatic and systems interventions to address the underlying behavioral, biomedical and structural drivers for new HIV infections and support delivery of a harmonzed and timely multi-sectoral response. The report covers progress during the rst year (June 2017 to June 2018) of roll out of the PFTI. 12

15 2. Key processes in the rst year of roll out the PFTI 2.1 Engagement of leaders at national and sub national levels Borrowing from early lessons of the 90s when the HIV Prevalence markedly reduced from over 18% to around 7.2% in the 2010, the President prioritized re-engaging the leaders. Importantly these would act as channels of communication to large communities. Key to this The PFTI message hand book was developed and during the year it was distributed in over 93 districts to over 5000 leaders. The book contains key messages that leaders need to pass on to the communities in regard to HIV prevention. Engagement of Parliamentarians: The UAC oriented Parliamentarians on the PFTI as leaders to appreciate their roles in implementation of the strategy. This improved their participation and leadership in rolling out the strategy. In addition, the HIV Parliamentary committee with technical guidance from UAC developed the HIV communication toolkit for advocacy and oversight. Engagement of Cultural Leaders: The Cultural Leaders rolled out the Presidential Fast Track Initiative focusing community mobilization to advance the objectives of the initiative through their structures. The Olwekobaano in Busoga (brings together all clan leaders), Ekisaakatte in Buganda, Ekyoto in Bunyoro and annual cultural events have prioritized HIV prevention. 13

16 The Prime Minister of Busoga Kingdom Dr. Joseph Muvawala at the East Central PFTI forum - May 2018 Engagement of Religious Leaders: The Religious Leaders at inter-denomination level have endorsed position papers focusing on HIV prevention, male engagement and sexuality education SGBV and other social development programs. These position papers highlight structures to use for mobilization including their media houses. A section of religious leaders from Busoga region during the East Central PFTI forum - May 2018 A section of religious leaders from Bunyoro region during Mid Western PFTI forum - Feb

17 Engagement of District Leaders At sub national level, all districts and urban authorities adopted the Presidential Fast Track Initiative, signed the declaration to implement the PFTI strategies and developed action plans that are being implemented. Various districts are reporting discussing HIV issues in the council meetings. One of the RDCs from Mid Western Region Presenting at the Stakeholders Meeting for PFTI Evaluation The LCV ChairPerson and RDC of Kole District Attending the Mid North PFTI Forum 2.2 Engagements of Ministries Departments and Agencies on the Fast-Track Initiative Multi-sectoral teams constituted from the TWG have engaged the top and senior management of fourteen Ministries, Departments and Agencies (MDAs). These include: Of ce of the President (MOP), Of ce of the Prime Minister (OPM), Ministry of Education and Sports (MOES), Ministry of Works and Transport (MOWT), Ministry of Energy and Mineral Development, Public Service Commission, Judiciary, Land Commissions, and Ministry of Local Government (MOLG), Equal opportunities Commission (EOC), Electoral Commission(EC) and Ministry of Internal Affairs. Further still, UAC engaged the Permanent Secretaries in their monthly meetings on the PFTI and HIV Mainstreaming. The key outcomes from all these 15

18 meetings, was the adoption of the initiative and strategy to ending AIDS as public health threat by Districts engagements and rolling out the Initiative By the end of 2017, multi-sectoral teams constituted to form the TWG had visited a total of 93 Districts, reaching about 5000 district leaders and these were sensitized about the Presidential Fast Track Initiative. These districts developed operational plans for the roll out of the Initiative in their respective districts. Leaders engaged at each district meeting include District Chairman, Resident District commissioner, District Administrative Of cer and other members of the extended District AIDS Coordination Committee (DAC). Some districts covered include; Moyo, Adjumani, Yumbe, Gulu, Omoro, Pader, Agago, Kitgum, Lamwo, Nwoya, Apac, Oyam, Dokolo, Alebtong, Kole, Lira, Amolatar, Otuke, Kaberamaido, Amurru, Hoima, Kibaale, Kakumiro, Kagadi, Kyenjojo, Kabarole, Kasese, Bundibugyo, Ntoroko, Kamwenge, Masindi, Buliisa Kiryandongo, Nakasongola, Luwero, Butambala, Mityana, Mubende, Kyegegwa and KCCA Nakawa division, Kabale, Kisoro, Rubanda, Kanungu, Rukungiri, Nebbi,Zombo, Arua, Maracha, Koboko, Bududa, Manafwa, Butaleja, Mbale, Rakai, Sembabule, Bukomansimbi, KCCA (Rubaga), KCCA (Makindye), Mbarara, Isingiro, Ibanda, Buhweju, Kiruhura, Ntungamo, Bushenyi, Sheema, Mitooma, Rubirizi, Jinja, Kamuli, Kaliro, Buyende, Iganga, Luuka, Namutumba, Mayuge, Bugiri, Namayingo, Wakiso, Mukono, Buikwe, Buvuma, Kayunga, Nakaseke, Kiboga, Kyankwanzi, Mpigi, Gomba, Masaka, Kalungu, Lwengo, Lyantonde and Kalangala. Following the PFTI orientation in the districts, three regional accountability engagements to evaluate the implementation were conducted. These were in: 1) Kole district for mid North region 16

19 during; 2) Hoima District for Rwenzori and Bunyoro sub regions; and 3) in Namayingo district for Busoga region. Health promotion and demand generation campaigns were held to accelerate delivery and usage of health services in the regions. Key output from the fora include the leaders gaining more appreciation of the HIV/AIDS burden and the need to track the response in their communities. In districts where the PFTI has been rolled out, there is increased attention in HIV issues by district leadership. In year two, accountability fora will be conducted in the remaining ve regions to ensure country wide coverage. 2.4 Engagement with AIDS Development Partners (ADPs) and other stakeholders The Uganda AIDS Commission (UAC) has held meetings with the leadership of various ADPs, including PEPFAR, the AIDS Development Partners Group and the UN Country Team, to support the PFTI roll out. Consequently the ADPs have supported the roll of PFTI at national and subnational levels. Further, UAC has engaged the self-coordinating Entities (SCE) to ensure they are made aware of their roles in the roll out of the Fast- Track Initiative and to develop work plans of the roll out of the Initiative in their respective constituencies. Various nongovernmental agencies, that were engaged, made commitments to align their activities with the Presidential Fast-Track Initiative. 2.5 Engagement of leaders at international levels The President continued to demonstrate leadership by mobilizing leaders at regional and global level through hosting high level meetings at African Union and UN general Assembly where he mobilized leaders from equally affected countries to fast track the end to AIDS. 17

20 3. Achievements 3.1 Engage men in HIV Prevention and close the tap on new infections particularly among adolescent girls and young women The National HIV Prevention Roadmap ( ) The UAC revised and aligned the HIV prevention road map ( ) to the Presidential FastTrack Initiative (PFTI). The road map outlines HIV combination Prevention packages and implementation approaches that Uganda has prioritized to end AIDS by The road map highlights the roles and responsibilities of the different stakeholders in the multi-sectoral approach to streamline coordination of the HIV response in the country. Response to structural drivers of HIV infection among adolescent girls and young women During the year the line Ministries and Partners developed and implemented frameworks with activities to reach adolescent girls, young women and men, their families and communities with appropriate HIV Prevention interventions: Adolescent girl agenda: The Adolescent and young women inter-ministerial task force (chaired by the First Lady) developed a framework for addressing adolescent and young women issues, to guide all sectors on issues underlying their vulnerability to HIV. The National Sexuality Education Framework: The First Lady launched the national sexuality framework intended to provide guidance to various actors reaching in and out of school children, adolescents and young people. The national Parenting guidelines: The Ministry of Gender Labor and Social Development (MGLSD) nalized and launched 18

21 the parenting guidelines. The guidelines complement the sexuality education framework and speci cally aim to equip parents with knowledge and skills in raising children. The Gender Priority Action Plan: The MoGLSD nalized and launched a Gender Priority Action Plan that is currently being rolled out by the different partners The GBV policy and Action plan: These were developed and rolled out for use by different stakeholders. There are number of programs that are translating these frameworks into actions such as: The PIASCY program: This program targets in school children and equips with information and skills on responsible sexuality and reproductive health choices. The program has recently been reinvigorated and is being implemented in 42 districts under a USAID funded project School Reading Project; The Social Economic empowerment projects: These projects such as DREAMS, the Karamoja Empowerment Project, the Empowerment and livelihood for adolescents (ELA), and the Global fund catalytic program empower adolescent girls and young women (10-24 years) with skills and capacity to stay HIV negative and cope with the epidemic. Engaging men: In line with H.E. s call for men to test, there is expanded mobilization to engage men through male actions groups that has contributed to increased participation of men in HIV programs. As a result of these intensi ed efforts for men to test, over 2,179,692 men (>15years) tested during 2017, with 69854(3.1%), identi ed as positive. And up to 82% of these are linked to care. 19

22 3.2 Accelerate implementation of Test and Treat and attainment of the fast Track targets particularly among men and young people Consolidated HIV prevention and Treatment guidelines Uganda adopted and rolled out the consolidated HIV prevention and treatment guidelines that require all persons testing HIV positive to start ART treatment immediately. In addition the guidelines provide for provision of innovative HIV testing approaches, care and treatment in community settings, and more tolerable treatment regimens. As a result about 8.8 million individuals tested of whom about were positive. Out of those tested HIV positive, 62% were linked to care resulting in 1,081,733 (65431 children and 1,016,302 adults) cumulative enrolment on ART. The Hon. Minister of State For Health-General Duties Launching the Consolidated Guidelines for HIV Prevention and Treatment Nov Consolidate progress on elimination of mother to child transmission of HIV Elimination of Mother-to-Child Transmission (emtct) in Uganda continues to be the agship program that integrates HIV and 20

23 Reproductive Maternal Neonatal Child and Adolescent Health (RMNCAH) services for women and infants including male participation. The country is closer to the global milestone for emtct of achieving 95% antiretroviral treatment coverage of HIVpositive pregnant and breastfeeding women. In 2017, 91% of HIV+ mothers identi ed, were enrolled on antiretroviral treatment in PMTCT programme and 42% of HIV exposed babies received preventive antiretroviral drugs. However the six weeks and 18months MTCT rates continued to be above the global milestone of 5%. About 90% of the newly identi ed HIV positive cases in PMTCT setting are from mothers below the age of 24years. The National PMTCT Validation Committee During a training by WHO regional Office at Ridar Hotel Seeta April Ensurn eancial sustainability for HIV and AIDS response Domestic nancing is key to sustainable HIV response in Uganda. In line with the PFTI the country intensi ed efforts to increase domestic resources through: 21

24 HIV Mainstreaming: UAC developed and rolled out the HIV and AIDS mainstreaming guidelines in the country. The guidelines are meant to ensure that all public and private institutions implement HIV&AIDS mainstreaming activities in a uniform manner, set of minimum interventions developed that all sectors. The Government through the Ministry of Finance, Planning and Economic Development directed that for every entity 0.1% of planned recurrent funds should be allocated to HIV programming in the MDAs effective FY2018/19. This directive is estimated that it will generate at least USD 5million annually. The Min. Justice and Constitutional Affairs, Maj. General (Rtd) Hon. Kahinda Otafire Launching the HIV Mainstreaming Guidelines - Feb 2018 The AIDS Trust Fund: UAC has worked with Parliament of Uganda, Ministry of Health and Partners to develop the ATF HIV prevention and control regulation. The regulation is before Parliament for consideration. In the budget appropriation of the Ministry of Health, 10 billion UGX was proposed to start the ATF in 2018/19 in addition to existing budgetary allocation for the HIV interventions. 22

25 The One Dollar initiative (ODI): UAC working with Private Sector Self Coordinating Entity started the One Dollar initiative. The ODI is a private sector led voluntary domestic resources mobilization strategy to contribute towards nancing of Health including HIV. The initiative is estimated to raise an average of about USD 10 million annually for the next 5 years. 3.5 Ensure institutional effectiveness for a well-coordinated multi-sectoral response A well-coordinated multi-sectoral response is premised on strong and effective institutions to support planning, implementation, monitoring and reporting. The country has put in place the following measures to improve effectiveness of institutions in the HIV multisectoral response: Uganda AIDS Commission: The Coordination of the multisectoral HIV response has been strengthened by appointment of the new UAC board and Director General. The board is representative of the different constituencies (PLHIV, Media, Young people, academia, Private Sector, Culture, Religion, Parliament, Civil society and Public Sector) in the multi-sectoral response. The Minister for Presidency with UAC Board Members at the Inauguration at the UAC Board -Apr

26 Parliamentary oversight: At National level, Parliament has been providing national HIV status report in the plenary and at committee levels. In addition Parliament has provided consistent leadership and oversight in advancing the fast track initiative through monitoring of services delivery and engagement of leaders. The Parliamentary HIV Committee and related matters at the Mid-Western PFTI engagement Forum-Feb 2018 Decentralized response: The PFTI has been rolled out in 93 districts and all urban authorities. The districts and urban authorities have aligned their HIV plans (strategic & operational) to fast track the HIV response at sub national level. HIV quality Services: The Government through /ministry of Health has developed and rollout HIV testing services accreditation and certi cation guidelines. This will reduce on number of falsi ed HIV results Media engagement: The national broadcasting association (media owners and practitioners) has committed to provide media space and coverage at discounted rates to increase community level knowledge about HIV. In addition the media 24

27 has accurately and timely reported on key issues affecting HIV response in the Uganda. Accountability: As an accountability platform, the People s space held during PFTI has helped to amplify the community voices in policy formulation and accountability for leaders. Furthermore has helped to get feedback from their leaders on key HIV issues affecting community Political leadership: The President has continued to demonstrate leadership by mobilizing leaders at regional and global level through hosting high level meetings at African Union and UN general Assembly. Strategic information: The Uganda AIDS Commission and Ministry of Health, with support from Development Partners, nalized the Uganda Presidential Fast Track HIV situation room. The is a data visualization platform that aids decision making through provision of timely and user friendly information on HIV from different sources and providers. Currently the platform has been installed at UAC and MoH, in the next phase it will be rolled out to Parliament, President s of ce and other line ministries. Regulation of AIDS Services Organizations: The UAC in collaboration with the NGO registration Bureau at Ministry of Internal Affairs is developing standards to provide oversight for the assessment for registration and certi cation of AIDS services organizations to ensure alignment of their operations with the priorities in the NSP and the multi-sectoral AIDS response. 25

28 3. Challenges i. Delayed operationalization of the AIDS Trust Fund ii. Attracting and sustaining active participation of men in HIV services remains a big challenge that requires continuous innovative approaches beyond the HIV sub-sector. iii. Limited level of mainstreaming HIV services in the different sectors. There is limited understanding on how HIV should be incorporated in development programmes iv. Inadequate funding for the PFTI roll out. v. Persistent stock out of HIV testing, treatment medicines and supplies. vi. Lack of unique identi ers to track clients along the HIV continuum of care (testing, treatment and support services). This results in dif culty in quanti cation of commodities and reporting on services utilization. vii. There is a high burden of HIV among adolescent girls and young women and their partners. About 90% of the newly identi ed HIV positive cases in PMTCT setting are from mothers below the age of 24years. viii. High loss to follow up in HIV exposed infants ix. Inadequate work force to provide comprehensive HIV services (governance, coordination and service delivery). 26

29 4. Priorities for year 2 The implementation of the PFTI in year one has generated substantive momentum that has demonstrated positive results that will be consolidated in year 2. The priority areas for year two include: i. Strengthening the response at subnational level; ii. Enhancing domestic nancing and increasing ef ciencies in programmes; iii. Strengthening strategic information; and iv. Streamlining coordination of partners and compliance to the NSP. 27

30 Annex 1: Members of the PFTI core writing team Name Dr. Nelson Musoba Dr. Zepher Karyabakabo Dr. Peter Mudiope Ms. Enid Wamani Mr. Tom Etii Dr. Dan Byamukama Mr. Trouble Chikoko Mr. Komiljon Ahmed Ms. Elizabeth Mushabe Ms. RoseMary Kindyomunda Ms. Victoria Kajja Dr. Esther Nyamugisha Dr. Flora Banage Mr Quinto Rwotoyera Dr. Joshua Musinguzi Dr. Pande Steven Organization Director General - Uganda AIDS Commission DPRP - Uganda AIDS Commission Coordinator HIV Prevention, MoH DP - Uganda AIDS Commission Uganda AIDS Commission Uganda AIDS Commission UNAIDS UNAIDS UN Women UNFPA IOM UNICEF CDC DFA - Uganda AIDS Commission MoH MoH 28