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AIM Programme Final Report
The Uganda AIDS/HIV Integrated Model District Programme was funded by
the United States Agency for International Development
and implemented by JSI Research & Training Institute, Inc.
in conjunction with World Education, Inc.

© 2006 This report is made possible by the generous support of the American people through the
United States Agency for International Development (USAID), Award No. 617-A-00-01-00004-00. The
contents are the responsibility of JSI Research & Training Institute, Inc. and do not necessarily reflect the
views of USAID or the United States Government.

Text: Peter Eerens, Claire Wilbur, and the AIM staff
Stories: Joe Rosenbloom, Carol McCreary, and the AIM staff

To learn more about the AIM Programme, please visit www.jsi.com or contact:

Penelope A. Riseborough
Director of Communications
John Snow Inc., and World Education Inc.
44 Farnsworth Street
Boston, MA 02210
617-482-9485

www.jsi.com
www.worlded.org
Cover photos Amy Finnegan, Tamara Plush, Joe Rosenbloom
2 AIM Programme Final Report
A family of AIDS orphans in Pallisa District.
At the age of 15 one of the girls gave birth to her first child,
highlighting the vulnerability of children in these circumstances.

Photo: Caroline Turyatemba
The AIDS/HIV Integrated Model (AIM)
District Programme, Uganda
May 2001 - May 2006

The mission of the AIM Programme was to establish an effective and replicable district-level model that
would contribute to the decrease in HIV prevalence and incidence in Ugandan adults and children, and in-
crease the level of care and support to Ugandans affected and infected by HIV/AIDS.

The overarching goal of AIM was to help effect changes so that men, women and children could access and
utilize appropriate, affordable, and quality HIV/AIDS prevention, care, and support services.
AIM Programme Final Report 3
A refurbished Health Center IV in Bushenyi District shows stocks
for testing and injection safety measures for the waste manage-
ment of used needles.
Photo: Charles Nserikomawa
4 AIM Programme Final Report
TABLE OF CONTENTS

Foreword …..………………………………………….. 7
Letter from the COP. .…………………………… 9
Overview of AIM Results ……………………………… 11
The Ugandan Response to AIDS………………………. 13
The AIDS/HIV Integrated Model District Programme… 14
The Three Ones……………………………………….. 16

CONTINUUM OF CARE………………………….. 21
Services:
• Creating referral networks………………………... 22
• HIV Counseling and Testing……………………..… 24
• Adolescent and Youth-friendly Services ………..… 26
• Prevention of Mother-to-Child Transmission ..…… 28
• Blood Safety and Injection Safety …………………. 31
Treatment:
• Sexually Transmitted Infections …………………… 32
• Tuberculosis and HIV ……………………………… 34
• HIV/AIDS and TB Program Synergy ……………… 36
• TB and Community-Based DOTS ………………… 38
• Strengthening Laboratory Capacity ………………. 40
Support:
• Home-Based Care ………………………………… 42
• Orphans and Vulnerable Children ………………… 44

BUILDING CAPACITY
Organizational Development …………………………. 48
Training ……………………………………………….. 50
Grants ………………………………………………… 54
Involving People Living with HIV …………………….. 57
Communication in Support of HIV Interventions……. 63
Communication in Support of the Network Model… 66

CONCLUDING REMARKS &
LESSONS LEARNED …………………………….. 68

AIM Partners ………………………………………. 72
AIM Highlights: Timeline May 2001-2006 ………… 75
Acronyms …………………………………………... 78
AIM Grantees ……………………………………… 80
Map of Uganda …………………………………….. 84
AIM Programme Final Report 5
A orphan child supported by EWIEPID, an AIM

Programme grantee, in Nebbi District.
Photo: Caroline Turyatemba
“I have been impressed with the level of commitment Ugandan’s
have shown in combating this pandemic. You are out there actually
doing something. As Eleanor Roosevelt said, ‘It is better to light
a candle than to curse the darkness!”
Statement by Joel Lamstein, JSI President
at AIM End-of-Project conference, March 29, 2006
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FOREWORD
“Together let us share the challenge” is the call that the Uganda AIDS Commission has broadcast to
all in the continuing struggle against HIV and AIDS. Over the last two decades, since the HIV/AIDS
epidemic was first recognized in Uganda, it has required everyone—individuals, families, and com-
munities—to take up the fight against the AIDS scourge. In this supreme effort, they have needed all
the support we can give.

The AIDS/HIV Integrated Model District Programme (AIM) put individuals, families, and the com-
munity at the center of their response and went to the districts to work. For the last five years, AIM
has supported, strengthened, and enhanced the existing HIV/AIDS services in 16 designated dis-
tricts. AIM has supported training for medical personnel, trainers, health management staff, and vol-
unteers. AIM was not designed as a direct service provider, but through capacity building has al-
lowed those who are service providers to do their job better, reach more people, more efficiently and
effectively with enhanced services.

The AIM Programme is a story of partnership. The Uganda AIDS Commission, the Ministry of
Health, the U.S. Agency for International Development (USAID), the U.S. Centers for Disease Con-
trol and Prevention (CDC), and other members of the Life Advisory Group designed the AIM Pro-
gramme in late 2000. Since that time, it has been managed by JSI Research & Training Institute Inc.
with their partner, World Education Inc. and over the years many other partners have joined us in
our efforts. I acknowledge with appreciation the partners who were involved in supporting this ini-
tiative.

There is a saying that no one can tell the story of what happened in the community better than the
people themselves. AIM has worked with people living with the HIV infection to tell their story and
analyze what services they need (from prevention to treatment) to improve their quality of life. AIM
has also worked with people affected by HIV/AIDS: spouses, sisters, brothers, mothers, fathers,
grandparents, and children—people in need and people trying to provide services for others. Now
the links between them are stronger.

Finally, I wish to encourage everybody involved in providing services for health and HIV/AIDS to
read this report. I am sure that they will find it most informative and the lessons learned over the last
five years most useful.

Dr. David Kihumro Apuuli
Director General
Uganda AIDS Commission
AIM Programme Final Report 7
Harriet Amuron, Project Coordinator at
COMUPACT, an NGO supported by AIM.
Photo: Caroline Turyatemba

“
The youth in our project area are
behaving more sensibly.
We’re doing something good.”
Harriet Amuron, Project Coordinator
COMUPACT, Kumi District
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LETTER FROM THE CHIEF OF PARTY
Since 1983 when the first AIDS cases were recorded, Uganda’s government and its people have been confronting the HIV/AIDS
crisis, promoting behavioral changes to prevent the disease, and treating people who have been infected or disadvantaged by it in
countless ways, great and small. Despite Uganda’s exemplary record among African nations in responding to the epidemic, its
progress in combating HIV/AIDS throughout the country and its healthcare system have been uneven because of limited re-
sources. As of 2001, basic services to test for HIV and care for people affected by AIDS were woefully lacking outside the capi-
tal of Kampala. Such was the case in most of the country’s districts (which then totaled 56). The capacity to improve services in
the district and sub-districts was generally weak. Where government and nongovernmental services were available, they often
functioned without effective coordination between them. From 2001 to 2006, the Uganda AIDS/HIV Integrated Model District
Programme (AIM) assisted Ugandans to strengthen district structures and services. Funded by the United States Agency for In-
ternational Development (USAID), the $39.4 million effort has been one of the largest, most diverse technical-assistance pro-
grams of its kind in Africa.

The AIM Programme served as a catalyst to develop model strategies and initiatives in the response to HIV in 16 of Uganda’s
districts—8 million people inhabit those districts; about 30 percent of the Ugandan population. Its overall project objective is for
men, women and children in selected districts to access and utilize appropriate, affordable and quality integrated HIV/AIDS/TB
prevention, care, and support services. AIM has also provided technical assistance and partnered with governmental and nongov-
ernmental institutions on the national level. The Programme has been implemented by JSI Research & Training Institute, a non-
profit health consulting agency, with its partner, World Education.

AIM’s story, above all, is a tale of many partnerships. It is the story of AIM working with district-level agencies and non-
governmental groups. The rationale for partnering was simple: to extend comprehensive AIDS care and support—a continuum
of care—to Ugandans in rural areas where the vast majority of people live, we had to strengthen many small organizations oper-
ating locally. Over the five years of the Programme, AIM awarded 459 grants to a wide variety of Ugandan organizations. The
grants have been small in size, averaging US$22,000 (Ugandan shillings 40 million). Most have been awarded to small, commu-
nity-based groups.

One central goal of AIM has been sustainability—that is, building services and organizations that will outlast AIM and continue
to operate effectively after AIM ends. To achieve this objective, AIM has conducted capacity building for the District HIV/AIDS
Committees (DACs) and national NGOs, developed the concept of the model district and the Referral Network for HIV/AIDS
(RNA), and provided grants and support for training and infrastructure improvements to strengthen and expand delivery of core
HIV/AIDS/TB prevention, clinical, care, and social support services.

With support from USAID, AIM accepted the additional role of assisting the 16 priority districts in battling tuberculosis, a dis-
ease inextricably linked to HIV. Woven into the fabric of many AIM-supported programs there is also now a strand for TB
healthcare services. A counseling program affiliated with an antenatal health clinic in the Arua district, for instance, now advises
pregnant women on the importance of treating TB and other opportunistic infections that strike people with HIV/AIDS.

Training was a key component of the Programme. Cumulatively, 43,489 people have been trained with AIM support. There has
been training of the leaders of nongovernmental groups in organizational skills and management capacity. There has been train-
ing of trainers of various kinds. There has been training of service providers in HIV and other related healthcare matters. Train-
ing has been conducted in each of AIM’s core intervention area: orphans and vulnerable children, adolescent-friendly services,
prevention of mother-to-child transmission of HIV, counseling and testing, blood and injection safety, sexually transmitted in-
fections, and home-based care. Furthermore, training interventions have been targeted towards tuberculosis and HIV/AIDS syn-
AIM Programme Final Report 9
ergy, involving people living with AIDS, and communication in support of HIV and AIDS interventions.

In January 2004, AIM refined its focus to reflect the objectives of the President’s Emergency Plan for AIDS Relief (PEPFAR),
the U.S. government’s HIV/AIDS strategy for Uganda and 14 other countries in Africa, Asia, and the Caribbean. One of the
PEPFAR priorities is helping children orphaned or vulnerable due to AIDS and thus this became a new emphasis for AIM mid-
way through the project. Another top PEPFAR priority has been promoting and expanding Ugandans’ access to HIV/AIDS
counseling and testing. PEPFAR’s engagement in the issue supported and refocused AIM’s on-going efforts in this area. Among
it’s many activities, AIM supported peer counseling programs, which were instrumental in mobilizing people for testing and
counseling those who test HIV positive.

Much of AIM’s legacy is quantifiable. For instance, AIM helped the Government of Uganda to establish 114 sites for HIV coun-
seling and testing and 84 sites for the prevention of the transmission of the virus from mother-to-child. Notwithstanding enor-
mous challenges, AIM’s successes are now apparent. Residents of selected districts and sub-districts, particularly pregnant
women, now enjoy increased access to quality HIV prevention services. People living with HIV and their families have greater
access to HIV and AIDS care and support services, thanks to partner efforts and training programs for more than 28,000 in the
areas of home-based care, opportunistic infections and TB, orphan and vulnerable children support, voluntary counseling and
testing, and laboratory services. The collection of better-quality information and its more strategic use in decisionmaking has
been enhanced by the more than 1,400 individuals trained in monitoring and evaluation techniques during the program. AIM
also has been pivotal in launching district-wide networks of HIV peer-support and advocacy groups, involving 60,000 people, in
15 of the 16 model districts.

Of course, not everything of lasting value can be reduced to statistics. The enhanced capacity of AIM’s partners to manage their
organizations and seek other sources of funds, the closer coordination among the many agencies and groups, an emboldened
spirit among Ugandans drawn to the HIV/AIDS cause through the AIM-supported programs, are gains—which are hard to meas-
ure but nonetheless real. Further, some of AIM’s most important successes have resulted from its partners harnessing remarkable
volunteerism among Uganda’s citizens.

This report provides an overview of the AIM Programme working in concert with its national and district partners. It presents
the on-the-ground innovations and services AIM has implemented along the continuum of care that enhance service delivery for
those various target groups infected with and affected by HIV and AIDS. This report looks at treatment and services. As stated
earlier, none of the advancements would have happened without our partner’s abilities being strengthened. AIM built capacity
through organizational development, training, and grants. This report also reviews how the people of Uganda have been engaged
in helping to provide services and efforts to reach them to change their behaviors. It is not an exhaustive report of the five years
of the programme, but rather designed to give project-relevant information (needs, interventions, and outcomes) in an accessible
format.

AIM would like to thank the many groups who have worked with us and the many people who willingly gave of their time and
energies every day to battle HIV/AIDS—as well as those who kindly spoke up and contributed to this publication.

We hope you recognize yourself in this report.

Med Makumbi
AIM Chief of Party
And all the staff at AIM (2001-2006)
10 AIM Programme Final Report