Reach Out Quarterly Report April June by MikeJenny

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									                                   Quarterly Report
                                   July-September, 2006




                                              Executive Director
                                              Dr. Stella Allamo Talisuna,
Chairman of Board of Directors                 MBchB (MUK). MDC (Antwerp),
Father Joseph Archetti                        IPH/CDC/HIV/AIDS FELLOW
Our Lady of Africa, Mbuya Parish              P.O. Box 6562
P.O. Box 6562                                 Kampala, Uganda
Kampala, Uganda                               Phone 041-2222630 Mobile: +256 77 2228844
                                                       +256 0712 22 99 44
Phone: 041-221 777
E-Mail: ourlady@utlonline.co.ug               E-mail: mrstalisuna@yahoo.com
                                              reachout@infocom.co.ug
                                              www.reachoutmbuya.org




                                             1
Acknowledgments
We would like to express our sincere gratitude to the CDC/PEPFAR program for this 2nd quarter’s ARV medicines and
the support costs that enable us to help so many of our clients, the World Food Program whose donations of food
supplies help to supplement ARV medicines to work, CONCERN Uganda and Worldwide whose friendship,
generosity and partnership we genuinely treasure and we find so useful in so many of our departments especially
funding for our M&E unit, the Stephen Lewis Foundation who has given so much to our Training Program, Bread of
Life micro-loan program and our construction program, PSI for their community education donations and their support
of our Roses of Mbuya workshop through on-going contracts.

Special thanks also go out to the Elton John Foundation, Kampala Arch-diocese, Plan International, IPH, PSI,
Uganda Biker’s Association, the World Bank, Soroptimist women’s group in Denmark, VSO and others.

We also remember Our Lady of Africa Parish whose members are so patient and kind to us by lending us the space
to do our work. Also Global Fund/MOH and the National TB program are to be thanked for the donation of much
needed medicines, World Children’s Fund for their continued and faithful support that helps us to aid more children,
AVSI and Side Cole whose donations enable so many children to continue their education.

We also thank all of our individual donors, especially Gary & Jones and many of whom are long-time friends who’ve
helped more students remain in school this year. Thanks also go out to the Infectious Disease Institute for their
contribution of personnel and resources during their visits to our clinic. We also must not forget all of our donors who by
their donations and prayers have kept us going this Second Quarter and who we rely on to keep us afloat in the coming
year.

Lastly we cannot forget Dr. Margrethe Junker’s contribution to Reach Out and as she moves to Mozambique. We
wish her all the best in her endeavours.




                                                            2
                                          TABLE OF CONTENTS

Introduction                                                                         7
Quarterly Main Findings                                                              7
   Medical Support Department                                                        7
   Counseling Section                                                                7
   The Clinic                                                                        9
   Treatment Implementation Unit                                                    11
ARV Section                                                                         11
Drug adherence                                                                      12
TB program                                                                          13
Enrollment:                                                                         14
Deliveries and PMTCT out comes:                                                     14
PCR/HIV Transmission out comes                                                      14
Infant deaths                                                                       14
   Pharmacy Section                                                                 14
Community Support Department                                                        16
   Community Network of Care                                                        16
   Food and Nutritional Support Section                                             16
Planned                                                                             17
   Friends for Life                                                                 17
Social Support Program                                                              19
   Bread of Life (BOL)                                                              19
   Operation School Fees (OSF)                                                      20
   Roses of Mbuya-Sewing Workshop                                                   21
Program Implementation Support Department                                           22
   Monitoring & Evaluation                                                          22
   Operation Support                                                                22
   Finances                                                                         23
General achievements, Challenges & Future Prospects                                 26
   Annexes                                                                          28
   List of Acronyms                                                                 28
   Table: Clients counseled, tested and received results by gender and age group.   29




                                                     3
Quarterly Highlights
    •        At the end of July 2006, we had 2,148 (67.3% females and 32.7% males) During this quarter we had 2277
             active clients (1507 females and 770 males) on clinical care representing an 5.7% increment in the number of
             active clients over the previous quarter whereas the number of new clients in the entire quarter was at 290.
    •        All our 2277 active clients are receiving Cotrimoxazole prophylaxis.

MEDICAL SECTION
Counseling
   • A total of 984 people turned out at Reach Out’s sites of Mbuya, Banda and Kinawataka for group voluntary
       HIV counseling sessions and thereafter 108 people declined the offer to proceed with individual counseling
       Only 978 tested, 55.67% were females and 44.4% male representing a signifant (p=0.0035) increase over
       38.3% of last quarter.
   • Of the men and women who had VCT during the quarter, 43.7% and 56.3% tested HIV positive respectively.
       Overall, 35.7% of those testing for HIV/AIDS were positive compared to last quarter’s 41. 5 %.
   • This quarter, 215 children (115 females and 100 males) aged < 18 years tested for HIV and 43 of them (24
       males and 19 females) were found HIV positive.
   • A total of 32 couples attended our VCT services, 14 were found discordant representing a discordance rate of
       43.8%

Clinic
    •        During this quarter we had 7,552 clients’ consultations in the clinic, of which 5,058 were females and 2494
             males. This represents a 5.5% increase over last quarter’s.
    •        117 home visits were made this quarter and this was less compared to last quarter’s 143 home visits.
    •        The use of morphine for pain management is now being applied in improving our palliative care


Treatment Implementation Unit
       • We had 1068 active clients enrolled on free ARVs. A total of 128 new clients (48 males and 80 females
            were started on ARVs during this quarter. This total was almost the same finding as last quarter’s 124.
       • At Reach Out Mbuya adherence continues to be high. Over 84.1% of Reach Clients this quarter, adhered
            at above the WHO set standard of 95%.
       • 22.6% of the 771 clients (both new and old) had a CD4 count lower than 250 and all those who had not
            been on ARVs before were initiated. Some new clients coming to Reach Out continue to present with late
            stage HIV infection and are in need of ARVs. We suspect that these very sick people have been living
            outside our catchment area and thereby choose to resettle in our catchment area so as to access free
            HIV/AIDS care – an indication that the demand for ART services is still very high in Uganda thus the need
            for expansion.
       • By the end of last quarter April-June 2006, RO had 60 new clients enrolled on TB. This quarter we had 47
            new clients and there were 29 existing and 11 new extra pulmonary TB cases whereas there were 78
            existing pulmonary TB cases out of the 109 active TB clients.
       • 34 clients completed their TB treatment while only 9 TB clients were lost to follow up. A total of 52
            expectant mothers were the active PMTCT clients whereas 35 new clients were enrolled onto the
            program this quarter. All 19 PMTCT clients successfully gave birth and 11 babies have so far been tested
            for HIV. 10 babies tested negative while 1 positive and the others are yet to be tested.
       • A total of 37 deaths occurred this quarter, a finding less by 6 deaths from the previous quarter. 13 of
            these clients were on ARVs, 6 on TB drugs and the rest on prophylaxis alone.

    Medical Training Department
     • A total of 20 trainings have been carried out this quarter
         •     5 Doctors, Nurses and Medical Clinical Officers attended C.M.E. every Wednesday and Thursday
               between 8.30 – 9.30am and this ongoing throughout the year.
         •     All Medical section heads and some assistants were trained in M&E program applications



                                                             4
COMMUNITY SUPPORT SECTION
Friends for Life – Community Outreach Programme

•   Friends for life this quarter carried out 273 activities out, of the 358 planned activities. Through these activities
    9080 persons were reached in RO’s catchment area. Of these persons 3780 (40%) are males, 5300 (57%)
    females and 307 (3%) newly reached.
•   FFL disseminated 180 basic care packages and 100 cartoons of water guard, held three trainings, enrolled fresh
    learners in adult literacy, developed a new method of message delivery for the in-school program, had refresher
    classes for the PSI educators, distributed loans to groups/individuals and recruited 2 new facilitators.

Community Network of Care
   • The program, through the CATTS network, took care of the entire 2277 active clients in Reach Out’s
     catchment area through provision of home based care to at least every client per month.

Food Programme
    • At the beginning of this quarter, there were 1,081 planned primary beneficiaries and at the end of the quarterly
        period the actual primary beneficiaries were 1,018 clients.
    • There were 5,339 planned secondary beneficiaries and the actual beneficiaries turned out to be 4,960 clients.
    • At the end of July 2006, 316 clients were phased out of the food program
Bread of Life – Microfinance
    • 61 RO clients were given loans (17 males and 44 females) and of these 26 were individual first time loaners
        while 35 clients were second or more time loaners.
    • 46 clients received business training skills and 15 were males while 31 were females. Clients from the
        Kinawataka service outlet had the highest turn up of 19 clients with the least coming from Banda with only 12
        clients.

Operation School Fees
   • By the end of the third quarter we had a total of 546 supported children (274males and 272 females) through
        this program.
   • 443 were RO clients’ children while 103 were others who are composed of needy and other parishioner’s
        children supported mainly from AVSI grants.
   • 2 children died while on the program and a further 2 left the program.

Roses of Mbuya Sewing Workshop
   • This quarter ‘Roses’ have posted a net profit of approximately 10 million Ug Shs. This is the first quarter where
       ‘Roses’ have recorded all costs including the overhead costs and stipends. This is a major step for the Roses
       and means they are on the road to self-sufficiency.

PROGRAMME IMPLEMENTATION SUPPORT SECTION

M&E
   •    This quarter, the department embarked on a capacity building training workshop which was co-funded by IPH
        and a list of facilitators of vast knowledge were used by RO in executing this activity. Trained were all
        department heads and their deputies who may be charged with over looking data and reporting.
    •   The Department has improved and continues to improve on data quality, databases, data collection and
        streamlining reporting systems as well as increasing on technical staff capacity building.

Operation Support
   • The new RO office building at Mbuya has been completed and will be occupied in October 2006.

Human Resources



                                                           5
•   There was one major recruitment of a clinical officer, a Medical Officer, one temporary Support Staff for
    Kinawataka and 2 more support staff for Reach Out Mbuya headquarters.
•   We also got a Volunteer that came in to help with the Client Registry Section.

Communication
    •   This quarter, RO had a total of 264 visitors, most notably the British High Commissioner Mr. Gordon
        Francois, the British member of Parliament Mr. Jeremy Hunt, Ms. Chiaki Warner and Ms Yuko
        Takehara from the Japanese Embassy.
    •   3 Reach Out volunteers attended a consortium of grandmothers with the Stephen Lewis Foundation
        in Canada (Building a functional Community of grandmothers and their dependants – a road to
        meaningful and sustainable livelihood).
    •   3 other volunteers attended the XVI International AIDS Conference in Toronto- Canada.


Finances
• In the third quarter, the total income we received from grants and donations, income generating activities and in -
    kind food from World Food Program came to Ug shillings 669,950,166 or US $ 372,194.54. Grants and
    Donations came to Ug Shs 551,880,616. (US $ 306,600.34)
• RO continued to strengthen income generating programs. Their contribution to the program this quarter went up to
    4.86 % of the funds used, this gives us a ray of hope towards sustainability.
• The operational costs of Reach Out Mbuya in the Third Quarter came to a total of Ug Shs. 527,073,396 (US
    $292,818.55) or 82.38% of the entire program costs.




                                                           6
Introduction
Reach Out – Mbuya Parish HIV/AIDS Initiative is a project under Our Lady of Africa Church, Mbuya, Kampala. The
project was initiated in May 2001 by a physician working in collaboration with the parish priest of Mbuya. Reach Out’s
main objective is to provide to People Living with HIV/AIDS in Mbuya Parish with free medical care, social, spiritual and
emotional support. Special focus is given to those to whom such services are out of reach i.e. the poor. Through
adoption of a holistic health care philosophy, the staff and volunteers of Reach Out believe that health service delivery
must include efforts to break the vicious cycle of ill-health and desolation, striving to restore health in its entirety,
defining each component as necessary for the delivery of a minimum health care package.

Reach Out’s implementation started with three volunteers who catered for the needs of 14 clients living with HIV/AIDS.
The program has experienced rapid growth since its inception in May 2001. The organization by the end of this quarter
was catering for over 2277 active HIV positive clients with a team of about 232 volunteers, 63% of whom are clients
themselves, delivering support through 11 health and social programs. The number of enrolled clients at Reach Out
has doubled in the last year. Considered alone, the simple number of clients that are catered for within the numerous
social and medical programs obscures the true magnitude of the work that is being done – on average, 114 new clients
are enrolled every month and each client enrolled for support within the Reach Out program is supported through 7 to
10 clinic encounters a year excluding other additional encounters with numerous social support programs.




Quarterly Main Findings

Medical Support Department
The Reach Out Medical Support Program is run by several sections including Counseling, Clinic, Reception,
Laboratory, the Treatment Implementation Unit (T.I.U) as well as the Medical Training and Pharmacy sections.

Activities of the medical support program are executed by a medical coordinator and team, together with the help of
other departmental coordinators to ensure that quality services are rendered to clients. This department, by the end of
quarter, was supported by a team of 5 full time doctors and 21 nurses. 3 doctors are doing clinical work full time, one is
managerial and one split between management and clinic. Of the nurses, 13 do clinic consultations, 3 work in the
pharmacy, 3 in the T.I.U department and 1 works in the counseling section. There is also an addition of 6 trainee
nurses. All nurses at Reach Out have trained as nurse practitioners and have built a wealth of knowledge through
ongoing continuing medical education (CME) every Wednesday and Thursday between 8.00am to 10.00am as well as
ongoing peer education among clinicians during clinic schedules. The counseling department has 5 trained counselors
and 5 counseling aides while the Reception which is charged with client record keeping, is composed of 10 staff.

Counseling Section
 The counseling section receives all clients who come to Reach Out for HIV testing. Counseling is done in three major
forms; pre, post and on-going counseling which is offered to those HIV+ clients who have enrolled into Reach Out’s
program. The department has continued to give quality-counseling services this quarter.

Pre and post test counseling
During the three months period of July to September 2006, 11 people who were counseled under group counseling
sessions declined to proceed with individual counseling sessions and the rest of the process prior to HIV testing and
receiving results. This finding is no different from other quarterly findings. Below is a table detailing the VCT outcomes
during the quarter.




                                                            7
  Clients counseled, tested, received HIV test results and enrolled onto Reach Out’s care, support and treatment
  program (July- September, 2006)
                                                 Positive Results                                                          Negative Results
                                  Total                                                                                                                   Quarterly
                                  counsel                                      Quarterly Period
                                                                                                                                                          Period
                                  ed,
                                  tested &                                                              No.
Sex                               received Jul                                 Total                    Enrolled for
                                                       Aug         Sept                                              Jul             Aug        Sep
                                  results                                      No.            Rate      care,                                             Total      Rate
                                  in                                           Positive       (%)       support and                                       Neg        (%)
                                  Quarter                                      s                        treatment at
                                                                                                        Reach Out

Male                              434            49    51          45          145            33.4      131                96        109        84        375        66.6

Female                            544            61    68          75          204            37.5      159                115       116        109       254        62.5

Totals                            978            110   119         120         349            35.7      290                211       225        193       629        64.3

                  The upward trend of increase in the number of people who turn up for VCT and receive results has prevailed
                  every quarter and this quarter’s findings were at 978 clients while last quarter’s was 919 clients.
              The percentage of males attending VCT has also increased from 38.3% last quarter to 44.4% this quarter.

  Paediatric /OVC Testing
  Towards the end of March 2006, child counseling and testing was introduced and last quarter (April-June 2006) saw
  33 children tested and results given to their guardians /parents. During this quarter, 215 children <18 years (115
  females and 100 males) were tested for HIV/AIDS and 43 (24 males and 19 females) were found HIV positive.

  New HIV+ clients
  Out of all the 349 clients who tested positive in the three months of July-Sept 2006, a total of 290clients turned up to
  receive clinical care from Reach out in this same period. However, there has been a decrease in the percentages of
  people enrolling onto clinical care in the aftermath of testing HIV positive from 89.8% last quarter to 83.1% this quarter.
                                            Percentage of People seeking VCT w ithin catchm ent area testing HIV positive by
                                                                              quarter


                                    60
                                             55             55
         Percentages of clients




                                                                          53
                                    50                                                    49
                                                                                                         44                           42              41.5
                                    40
                                                                                                                                                                    35.7
                                    30
                                    20
                                    10
                                     0
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                                                                                                 8
Couple counseling and testing
This is intended to promote family dialogue as well as decision making in mainly seeking couple treatment and to
reduce on gender based violence that may arise from discordant and even concordant results. Other major issues
addressed include enhancing a conducive environment for post-test decision making for both concordant and
discordant couples.

Discordant Couples’ Intervention
Reach Out has highlighted discordant couples as key beneficiaries for prevention programmes and it’s counselors
designed interventions that aim at reducing the risk of HIV transmission within discordant couples. The intervention
sessions focus on the key issues discovered in the needs assessment, such as “Understanding Discordance,” “Risk
Reduction” and “Couple Communication”. Below are the results for this quarter.

Categories of results received from couple testing
Couple          July        Aug        Sept        Total
Results                                            couples          During the last quarter,
Discordant      4           8          2           14               out of 25 couples tested
Concordant      4           2          2           8                 for HIV, 8 were found to
positives                                                            be discordant.
Concordant      3           2          3           10
negatives
Totals          13          12         7           32

On going/follow up counseling
The main aim of follow up counseling is to make sure that the HIV+ client continues with a positive attitude towards life
that would enhance future planning for themselves and their families. 173 clients were followed up on different issues
for counseling (adherence, alcoholism, domestic violence, social problems e.t.c) in the three months of July-
September, 2006.

Alcoholic Anonymous Club (A.A)
During the quarter of July –September 2006, 43 clients facing alcoholic problems turned up for their AA
sharing and learning meetings under the facilitation of two counselors, these meetings take place every
Tuesday and Friday of each week through out the quarter.

The Clinic
Reach out is a Nurse Driven program with regard to its clinic operations. None-the-less a doctor is available at every
clinic to assist with difficult clinical problems and to provide training. The client numbers continue to increase every
quarter and RO continues to run four clinic days with one Home/hospital visit day. For each clinic day, two clinics run
concurrently due to the demands from the increasing number of clients and this brings about space problems

Clinic consultations
During this quarter we had 7,552 clinic consultations of which 5,058 were females and 2494 were males. This
represents a 5.5% increase from last quarter’s 7,137 clinic consultations. In July, August and September 2006, RO
handled 2445, 2698 and 2409 clinic consultations respectively.

Client status update
At the end of June 2006, we had 2,148 active Clients and by end of September 2006 we had 2277 active clients (1507
females and 770 males) on clinical and social care representing a 5.7% increment in the number of active clients over
the previous quarter. .




                                                           9
                                      Status of Clients, July- Sept 2006

                  350

                                                                         290
                  300

                  250
                                                                                              Newly Enrolled
   N of clients



                  200                                                                         Died
                                                                                              Left
                  150                                                          127            Transferred
    o.




                         108              101                                                 Re-admitted
                  100                                      81
                               52
                                                42                            37
                  50                                          33
                           14    11         13              10                     1812
                                      1              7 7           0 4
                    0
                               July             Aug             Sept          Total
                                                      months


Screening
T.B and Cryptococcus meningitis screening
On enrollment into the program, clients CD4 counts are done and all clients who have a CD4 less than 100, are quickly
screened for TB and cryptoccocal meningitis. TB screening is ongoing for all clients who’ve been enrolled onto the
treatment program. This helps with early detection and proper management of this deadly opportunistic infection which
is highly prevalent among the poor clients we serve.
Cryptococcal meningitis screening
Before ARVs are initiated, all clients with CD4 100 and below are routinely screened in addition to diagnostic testing.
We have been able to capture some asymptomatic clients with positive CrAg tests and thereby institute early treatment
and reduce mortality. 5.6% of the 107 clients screened during the quarter tested positive, a finding similar to last
quarter’s 5.4%.

Laboratory Diagnosis
        The Table below details the lab outcomes during the quarter.
                  TEST                                           NUMBER               POSITIVE              NEGATIVE
                                                                 TESTED
                  CrAg                                           107                  6                     101
                  Liver function Test                            62                   29(Abnormal)          33(normal)
                  Sputum           Diagnostic                    135                  3                     132
                           Sputum monitoring of those on TB      35                   00                    35
                           Routine on enrolment                  356                  26                    330
                  HCG                                            43                   24                    19
                  Blood slides to rule out mps                   39                   04                    35
                  Biopsy                                         4                    -                     -
                  Widal test                                     6                    --                    6
                  CXR (Bugolobi)          Baseline+Diagnostic    325                  306                   19
                                           Follow up             34                   --                    34
                  Abdominal ultrasound scan                      12                   --                    --
                  Urinalysis                                     14                   5                     9
                  Stool analysis                                 11                   1                     10
                  Hb                                             195                  35(8.0 gld)           160 (8.0 gldl)
                  VDRL                                           14                   1                     13
                  Toxoplasmosis Test                             17                   14                    13
                  Toxo titres                                    --                   --                    --
                  Random Blood Sugar                             2                    --                    2
                  Hepatitis B                                    --                   --                    --


                                                                         10
        CBC                                        20                 4 abnormal               16
Home Visit Records
We continue with weekly home and hospital visits with occasional emergency home visits as the need arises

Table below shows number of clients visited during home/ emergence visits
                      SEX                                                                    This finding exhibited a
MONTH                                                TOTAL                                   decrease in the number
                      MALES          FEMALES                                                 of emergence visits
                                                                                             made this quarter as
                            14            29               43                                compared       to     last
July                                                                                         quarter’s 143 emergency
August                      14            27              41                                 home-visits, an indication
September                   15            16              31                                 that RO clients are
                                                                                             adhering more to their
Total                       43            72              115
                                                                                             drugs.


Treatment Implementation Unit
This department carries out various activities with emphasis on community involvement in close follow-up of all clients
on ARV, TB and PMTCT treatment with an aim of achieving maximum adherence. The T.I.U was formed in response to
declining adherence and increasing numbers lost to follow up. Its main objective is to ensure effectiveness, quality care
and close follow up of clients.

ARV Section
 Activities carried out by this section include: ARV education to clients and their care givers, CD4 count screening,
monitoring and adherence counseling, pre-ARV home assessments, follow up home visits and enrolment of new clients
on ARVs. The ART section has continued to expand since 2004. The clients still access their drugs from the three main
sources i.e. MOH, PEPFAR and JCRC. By the end of last quarter, April – June 2006, we had total of 986 active
clients on ARVS from these 3 sponsorship sources.

The number of newly enrolled clients onto ARV this quarter is 128, which is almost the same number
compared to the last quarter’s 124. Among the newly enrolled this quarter, 6 were children (F=4, M=2), and
one child was started on 2nd line due to immunological failure.


Table below shows client numbers by status and by sponsorship category (July-September, 2006)
  Outcomes                                 No. of clients supported       Total
                                            by Donor
                                           JCRC       MOH     PEPFAR

  Active end of June                             60         489       437           986
  New clients enrolled this quarter              0          111       14            128
  Died this quarter while on ARV                 0          -9        -4            -13
  Lost to follow (Defaulted)                     -11        -6        -3            -20
  Physician stopped                              0          -3        -3            -6
  Changed from MOH to PEPFAR                     0          -3        3             0
  Transfer to other centers                      0          -5        -2            -7
  Transfer into Reach Out                        0          2         2             4
  Switched to 2nd line                           0          -1        1             0
  Re-started                                     0          0         0             0
  Active end of September                        58         568       442           1068
  Females                                        50         376       289           715
  Males                                          8          192       153           353



                                                          11
CD4 count
Before any of the clients are enrolled onto ARVs, their CD4 counts are assessed. Clients with CD4 count <250 are
eligible for ART. A total of 804 clients (265 males and 539 females) were screened/ bled this quarter and of these 276
clients (89 males and 187 females) were newly bled clients. The Table below details the clients CD4 counts by month.

The table below shows the percentages of a range of new clients bled this quarter.
 Month CD4 count          CD4 count         CD4 count            CD4 count                                      Clients    Total   newly
           < 100          101-250           251-499                 >500                                        eligible   bled
                                                                                                                for ART
                             No.       %        No. Of %            No. Of %                  No. Of %          %          No. of clients
                             Of                 clients             clients                   clients
                             clients
 July                        22        18.2     27          22.3    35             29         36         29.7   40.5       120
 Aug                         27        23.3     27          23.3    24             20.8           38     32.7   46.6       116
 Sept                        5         12.8     12          28.2    12             30.8       11         28.2   41         40
 Totals                      54        19.6     66          23.9    71             25.7       85         30.8   43.5       276

Though not significant, the percentage of clients eligible for ART this quarter dropped from 49% to 43.5%. RO’s
ultimate goal would be to provide Home based VCT so as to encourage access to care in the early stages of infection.
Moreover, those who test positive early could start on septrin prophylaxis hence delay progression to severe disease.

However it is still evident that very sick people resettle or move into our catchment area so as to access free HIV/AIDS
care – an indication that the need in Uganda is still very high thus the dire need for scale up to the rural disadvantaged
areas.

Drug adherence
At Reach Out Mbuya adherence levels continue to be high due to the good support systems right from the community
level up to the Treatment Implementation Unit whose main objective is to ensure and maintain good adherence.
Though not significant, the findings for RO’s clients adhering above the WHO set standard of 95% this quarter (which
were at 84.1%), were lower than those of the last quarter’s 89.9%.The graph below helps to illustrate adherence
percentages by month during RO’s third quarter.



                              Percentage of clients adhering at different WHO
                                 set percentage standards, July-Sept 2006

                           100.0
    Adherence percentage




                                                     85.2          87.2            84.1
                                   79.9
                            80.0
                                                                                                       >95%
                            60.0
                                                                                                       75-95%
                            40.0
                                       16.7                                                            <75%
                            20.0                       11.4          10.2                12.8
                                          3.4             3.4           2.6                 3.1
                             0.0
                                       July             Aug          Sept               Overral
                                                      Months in quarter 3




                                                                              12
TB program
By the end of last quarter April-June 2006, we had 60 newly enrolled clients, 38 were cases of pulmonary TB (PTB)
and 22 were cases of extra pulmonary TB (EPTB). By the end of this 3rd quarter we had 113 active clients. This quarter
we had 47 new clients of which 36 were cases on PTB while 11 were EPTB cases. RO had a total of 109 active TB
clients, 78 of whom were PTB cases.

The table shows TB diagnoses were made in clinic in the past three quarters.
Quarter       PTB smear PTB smear            PTB smear EPTB                                 TOTAL
              +ve            -ve             not done
Jan - March   12             15              13               12                            52
April - June  12             12              14               22                            60
July - Sept   16             12              8                11                            47
TOTAL         40             39              35               45                            159

Of the newly enrolled clients with PTB, 15 were smear positive, 12 were smear negative, 8 had no smear results in
their notes. In those cases with smear negative results and no smears done, the diagnosis was made by a combination
of history, physical examination and chest x-ray findings. A 32% smear positivity rate amongst PTB cases is
reasonably good, since the sensitivity of sputum smears is significantly reduced in HIV +ve clients.The number of those
who had no smears done decreased in the last quarter. This is due to the emphasis in clinic on using sputum in the
diagnosis of TB.

TB screening for new clients
Of the 237 clients screened for TB in the first quarter, 31 were diagnosed with TB, which is equivalent to 13.1%. In the
third quarter 285 were screened for TB and 26 were diagnosed with TB which is equivalent to 9.1%. This shows the
importance of TB screening.

Treatment outcome 2006 Quarters

                              Jan-March         April-June      July-Sept
Treatment cure                30                20              11
Treatment completed           81                32              23
Treatment failure             0                 1               0
Died                          9                 13              6
Defaulted                     6                 10              9
Transfer out                  5                 2               0
Total                         131               78              49


PMTCT
The section has continued with enrolment of pregnant HIV+ mothers, couple counseling on PMTCT, infant feeding and
immunization, family planning guidance, support of pregnant female clients as well as follow up of children born to
mothers under the PMTCT program.

 When a pregnant HIV+ woman is identified, they are referred to Naguru Health Centre or Mulago Hospital or other
health units for antenatal care and encouraged to deliver their babies from these health facilities. Here at Reach Out,
our CATTS make sure they follow up clients so as to ensure that they are attending and receiving quality antenatal care
services wherever they have been refered to. On approaching the eighth month of pregnancy, the CATTS scale up the
monitoring of these clients and provide those who didn’t come to Reach Out for services with Nevirapine to be taken at
the onset of labour.




                                                          13
                 The table below summarises the status of PMTCT services during this quarter
                                    Active (not delivered)    Newly            Deliveries
                                                              enrolled
                July                49                        11               2
                August              55                        18               8
                September           52                        6                9

Enrollment:
A total of 35 expectant mothers have been newly enrolled for PMTCT this quarter, 20 of whom were on ARVs and 15
were on prophylaxis only. Out of the 35 mothers newly enrolled this quarter, 8 couples attended PMTCT counseling
while 27 attended without their partners. 32of the 35 enrolled mothers were referred to Naguru health centre while the 3
opted for other medical centers for antenatal care.

Deliveries and PMTCT out comes:
19 mothers delivered live infants in this quarter. 10 of these were on ARVs and 9 were on prophylaxis and received a
single dose of Nevirapine at the on set of labor together with a seven-day course of combivir. Of the 19 live infants, 8
were females and 11 were males. They all received a single dose of Nevirapine syrup. Sadly, we had 3
reported abortions

PCR/HIV Transmission out comes
This quarter, 11 infants were referred for HIV/PCR testing at 6 weeks. 10 of these infants tested HIV negative while 1
tested HIV positive.

Infant deaths
Sadly, we had 1 infant death this quarter of who was HIV positive with PCR at 6 weeks of age due to measles
complications.

Death Summary:
A total number of 37 Reach Out clients died during this quarter, 13 of whom died while on ARVs and the rest on
prophylaxis. Of those on ARVs, 5 died in July, 5 in August and 3 in September. Out of these, 2 clients were on both
ARVS and TB and 11 clients were on ARVS only. 6 clients had CD4 count ranging from 100 – 250, 3 had CD4 count
ranging from 250 – 500 and one had CD4 count of >500. A sum of 3 clients had spent less than six months in the
program, 4 clients had spent a duration of six months to one year, and 6 had spent more than one year.

Observations:
   • Majority of the clients who died on ARVs had HIV related anemia and advanced HIV infection.
   • Most of the clients who died were new in the program

Pharmacy Section
There is really no marked change in the Pharmacy. The routine work is going on well, the pharmacy staff continues to
strive hard to achieve Reach Out’s goals and improve the quality of life.

Drug consumption
 Consumption of cotrimoxazoe for Prophylaxis continues to increase because it is prescribed to every client who is
tested HIV positive unless they are allergic to sulphurs.
Please see annex for further details on drug consumptions




Medical Training Section



                                                          14
This quarter, Reach Out continued its capacity building mission in ensuring that the medical support department
continues training its staff both internally and externally, as care of PHAs is still challenging especially in resource
limited settings. During this quarter the following was accomplished.

July:
• 5 Doctors, Nurses and Medical Clinical Officers attended C.M.E. every Wednesday and Thursday between 8.30 –
    9.30am and this ongoing throughout the year.
    One Medical Doctor attended a 5-day short course in pediatric HIV care at PIDC Mulago between 24th and 28th.
    One Nurse also attended a 5-day short course in PMTCT at Mildmay International Study Center (MISC) from 31st
    July - 4th August.

August:
          All clinicians attended a 2 hr session on pediatric nutrition.
          One Nurse attended a three-day training course on mentorship at Agha Khan University in Kampala.
          12 Nurses were on placement for clinical experience from IDI Mulago and Mildmay.
          2 UCSF residents were on clinical experience for 10 days
          2 Palliative care specialists were on placement for 10 working days (1 Clincal Officer and 1 Nurse).

September:
       One third year medical student was on placement for 3 weeks.
       All medical section heads and some assistants were trained in M&E application into programs

One nurse from the clinic section is attending a one and a half year course on the care and management of PLWHAs at
MISC and is expected to end in March 2007. Four counselors are attending a one-year course in guidance and
counseling at Uganda Catholic Training Center, Rubaga.

Reach Out continues to conduct courses for non-RO staff and in July 2006, 3 Medical students came for clinical
experience from University of California San Francisco and Sheffield University UK respectively. Each stayed for less
than 3 weeks. RO continues to train 6 trainees (2 Medical Clinical Officers and 4 Nurses) who were enrolled onto the
Comprehensive HIV/AIDS course in May 2006. In August the six trainees joined the clinical team after completion of
class sessions. This session of clinical rotation ends in October 2006 for this group.

Placements offered to external trainees
In July RO received 16 trainees from MISC, in groups of four, with each group participating in 1-day placement. In
August, at least 14 student counsellors were on placement for the whole month as they were on a practicum.
These students are studying their degree and Diploma courses from Kyambogo (5), Rubaga (8) and YMCA
(1).In September, one 3rd year Medical student from Montreal was on clinical experience for three weeks and a 4th
year Medical student from Hospice, Makindye – Kampala, was also on placement for one day to learn more about
holistic community based HIV/AIDS care. A team of 16 persons (Nurses, Doctors and Lab. Students), were on 3 hr
placement on their respective allocated days during this month.4 UCSF Residents were on placement for two weeks
per pair and 5 Palliative care specialist students from Hospice, Makindye – Kampala, were on placement for 2 weeks (3
and 2 students respectively). This month, 4 student counsellors from Kyambogo University were on
placement for the whole month as they were on a practicum.

Workshops and seminars / meetings
In July 2006, the medical training coordinator attended a two-day workshop at IDI on the 26th and 27th July 2006. It
involved approving tools for a Training Needs Assessment (TNA) for stakeholders involved in training health workers in
HIV/AIDS care delivery. In August, one counsellor attended a 5-day workshop in the development of a training
curriculum for positive prevention, at Mbarara. It was organized under TASO, Kampala.




                                                           15
Community Support Department
Community Network of Care
Community Network of Care is a composition of both clients and non- client volunteers who are responsible for taking
care of all the Reach Out clients from within their communities. However, the critical support is given to clients on ARVs
and TB medications. Clients on prophylactic treatment are monitored at least once per month. Community monitoring
and support of clients is very important for both the clients and the project. For the project it gives us a clear picture on
the impact of our services as well as helping us to carry out the needs-assessment socially, emotionally and physically
among our clients. The community support acts like a relay for information flow between the program and the
community.

For the clients, peer support goes along way in motivating them and giving them a better understanding of the social
dynamics of HIV. There is a continuous renewed effort towards improved adherence. The community network is the
major contributing factor to Reach Outs treatment outcomes. Overall clients are given HOPE for the future.

Our Community Network of Care to date is composed of:
    • 39 CATTS (Community ARV and TB Treatment Supporters) who are charged with daily follow up of clients at
       home offering them main adherence support but also giving psychosocial support.
    • 9 community supporters who are assigned to support the bedridden clients with the domestic chores like
       cooking washing and bathing them
    • 5 Central Supervisors, one for each of the five villages, who are community focal persons in-charge of
       supervising all community activities on behalf of the project.
    • A Network coordinator and his assistant.

The community network works very closely with the Treatment Implementation Unit, Clinic, microfinance, Food
Programme and Operation School fees program. The network meets weekly in each area and monthly for all area
networks to share experiences and develop strategies.

By the end of September 2006, we were taking care of over 2277 active clients from the different catchment areas with
Kinawataka still contributing to the bigger proportion of our clients. 192 clients were given material support in the form
of beddings (62 clients) and clothings (130 clients). 8 clients were recommended to get grants from RO’s micro-finance
program and all of them received.


Activities carried out during the quarter:

 Social support
We have continued with the scale up on community campaigns for loan recovery of our clients who had defaulted on
payment. Follow up on Loan defaulters is now high on the agenda. We are doing a lot of sensitizations during the
CATTS’ visits to the clients’ homes as well as holding community weekend meetings. We are so far registering gradual
success according to the reports we get from the BOL Loans department.

Tracing clients’ relatives
This activity started in June with the objective of offering psychosocial support to clients. Clients were helped to locate
their relatives through phone calls and home visits. Family support is very essential for adherence to drugs and reduces
stigma. Furthermore Family support reduces client dependency on the program and this activity was still on-going
during the past quarter.

Food and Nutritional Support Section
The food section provides food support to our clients through the World Food program (WFP). Food is now being
distributed to clients with the help of the use of identity cards. Some beneficiaries who failed the evaluations are still
food insecure and some are being considered for reinstatement. A list has been circulated to all community supervisors
and CATTS before a final list of phased out clients and those retained on food support can be released.


                                                            16
At the beginning of this quarter, there were 1,081 planned primary beneficiaries and at the end of the quarterly period
the actual primary beneficiaries were 1,018 clients. There were also 5,339 planned secondary beneficiaries and the
actual beneficiaries turned out to be 4,960 clients. At the end of July 2006, 316 clients were phased out of the food
program and that’s why we had fewer primary beneficiaries (631) for the month of August. We had 49 new food aid
clients during the month of September 2006. Normally, beneficiaries who’ve not collected food for a period of 3 months
are de-registered from the food aid clientele.

At the beginning of this quarter, we planned/ expected 465 ARV clients to be served on the food aid program, 425 were
served in July alone and due to the phase out process 300 ARV clients were served in August while 327 were served in
September 2006. For clients on TB, 177 were served in July, 110 in August and 121 in September were also served by
the food and nutritional aid program.

14 clients have been re-admitted into the program while 130 RO clients were enrolled as new clients on food
support.whereas 10 clients left on their own.

Food aid beneficiaries during this quarter (July-September, 2006)
            July                            August                             September
            Planned         Secondary       Planned       Secondary            Planned          Secondary
            Beneficiary Beneficiary Beneficiary Beneficiary                    Beneficiary      Beneficiary



Planned       1081            5339             763             3761            822              4107

Actual        969             4826             631             1036            680              1170

Difference    112             513              132             2725            142              2937

Friends for Life
Friends for life (FFL) is the prevention and sensitization arm of Reach Out. The community program aims at sensitizing
adults and out of school youth about HIV, stigma, malaria, and family issues. The Schools Program aims at sensitizing
secondary and primary school students about HIV/AIDS, STI/STD’s, equipping them with life skills to enable them
appreciate the beauty of life and make informed decisions. Adult Literacy seeks to help and enable clients
communicate with their clinicians and to increase literacy in our community.

Friends for life this quarter carried out 273 activities, of the 358 planned activities. Through these activities FFL was
able to reach 9080 persons in RO’s catchment area. Of these persons 3780 (40%) were males and 5300 (57%)
females while 307 (3%) were newly reached. In addition to our habitual duties we organized and held behavioral
change seminars, disseminated 180 basic care packages and 100 cartoons of water guard, held three trainings,
enrolled fresh learners in adult literacy, developed a new method of message delivery for the in-school program, had
refresher classes for the PSI educators, distributed loans to groups/individuals and recruited 2 new facilitators.

Out of school youth
This program has been running well this quarter with a focus on life skills and HIV/AIDS. We managed to hold most of
our planned discussions, sports, BCP seminars, quiz competitions and income generating activities like the pork joint.
As a result of these activities we reached 729 out of school youth, amongst which 475 males, 254 females and 129
new (refer to graph below). However we were not able to reach our full potential due to inadequate indoor games and
suitable, permanent place on our activities. Management should help support more of our activities.




                                                          17
      Percentage number of youth reached in
          (July, August, September 2006)
         through the out of school program
        New , 129,
          15%                               Males
                               Males,       Females
     Females,
                              475, 55%      New
     254, 30%



Good Samaritan program
Through discussions and role plays, this program has reached a total number 3659 adults in our community 916 (24%)
were males, 2743 (74%) females and 85 (2%) new persons. The Good Samaritan program focused on STIs/STDs this
quarter. The cooperative and savings group did well during the quarter with loans being lent out and more community
members joining and learning how to saving.

Operations Gideon
854 adult males have been reached this quarter and of these 36 persons are new (Represented in the graph below).
These persons have been reached through our weekly men’s discussions and role plays. The new centre opened is
fully functional and effective; the Y.E.A.H training acquired during this quarter has helped make these male activities
better and efficient. On the other hand, we have a challenge of expansion of the program as requested by participants
outside the catchment area, a deficiency in funds and a small number of competent facilitators to facilitate have slowed
down the expanding of the Gideon activities. The management should recruit more competent facilitators to handle the
male program.
          Percentage number of males reached
        in(July,August,September 2006) through
                     the Gideon program

                  New , 36,
                    4%
                                                    Males
                                                    New
                       Males, 854,
                          96%



In-school youth
The in-school program has got 17 schools it attends to in RO’s catchment area. Through discussions, debates, music,
dance, drama role plays and games; 2147 in-school youth have been reached among these 901 are males and 1246
females. Facilitators have improved their skills as a result of the trainings and refresher courses held. Life skills, “Being
a boy/ Being a girl,” “Growing and Changing” are the topics that have been handled in the schools this quarter.
Creditably due to the effectiveness of this program we have been requested by some of the schools to run our program
in their schools and others in their lower classes of Primary 3 and .4. This will take effect the next month.


Adult literacy
In this program, the learners have increased as compared to the last quarter by 24 new learners. This quarter we had
128 female adult learners (81%) and 6 males (4%).This class increase is due to the mobilization by the community
supervisors and the involvement of the CATTS. Despite the progress in the program activities we are short of suitable
meeting places and class room chairs for the learners. Next quarter the program will embark on increasing the number
of male adult learners.




                                                            18
Social Support Program
Bread of Life (BOL)
Bread of Life is a Micro Finance section in Reach Out. It is an important part of the holistic care for PHAs, which seeks
to directly address the needs arising from poverty. Our goal is to help clients achieve self-sustainability by giving them
loans to start new or expand existing income-generating activities and to help them move away from a state of
dependency thereby giving them an opportunity to support others instead of waiting for hand outs.

Bread of Life has substantially increased the number of loans it has provided each month. Loans of 100,000 –
500,000Ush are extended to clients and volunteers on a five months repayment schedule. All loans are extended with
a 10% interest rate. This is considerably much lower than commercial institutions and allows more impoverished
clients to borrow. Currently the demand for access to credit by our clients is far from being realised. Most of our clients
are very poor and many have been very sick. This means that sometimes they may fail to repay due to ill-health or
even death, or even do fail to develop a profitable profession for themselves and even lose their jobs.




                                     One of the loan clients in their shop


Bread of Life continues to run compulsory monthly business training workshops for first-time borrowers, to impart
valuable business skills to our clients. Topics covered include: how to create a successful business plan, how to handle
customers in business, keeping records and how to prepare or save for unprepared difficulties or/and other social or
domestic problems (incidentals such as sickness, death of relatives, house rent etc), among others.

61 RO clients were given loans (17 males and 44 females) and of these 26 were individual first time loaners while 35
clients were second or more time loaners. 46 clients received business training skills and 15 were male while 31 were
female and clients from the Kinawataka service outlet had the highest turn up of 19 clients with the least coming from
Banda with only 12 clients



Summary of the financial report at the end of the quarter
                                         Number         UGSHS                        Equivalent (US$)
No of people given loans                 88
Amount of loans given                                   11,165,000                   6,003
Collections :- Stipends                                 2,252,000
                Office                                  1,751,500
Total collections                                       4,003,500                    2,153


                                                            19
Amount outstanding end of qtr                                        45,622,550             24,528
No of loans outstanding – qtr                          650
People repaying in quarter                             325
People attended business training                      46
Notes: Exchange rate $1 = ushs 1860                     Amount outstanding includes monies to be written off.

Achievements:
       The computerization of the loan records has improved control and also made it easier to analyze the
       performance of the project. Graph below shows performance of BOL since beginning of this year.

                                      LOANS GRANTED VS. REPAID JAN -
                              12,000,000        SEPT 06
                              10,000,000
                    A O N (U H )
                     M UT S S




                                   8,000,000                                                                    Loans
                                                                                                                granted
                                   6,000,000
                                                                                                                Repay
                                   4,000,000                                                                    ments

                                   2,000,000

                                          0




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                                                                                               S
Operation School Fees (OSF)

Operation School Fees is a social support programme within Reach Out, which is responsible for educational support
of children of our clients and children who are clients themselves. OSF is also an important preventive programme as
children without education (especially the girl child) are at a high risk of getting HIV/AIDS when they grow up. A total
number of 546 children are getting school education through this programme.

By the end of the third quarter we had a total of 546 supported children (274males and 272 females) through this
program. 443 were RO clients’ children while 103 were others who are composed of needy and other parishoner’s
children supported mainly from AVSI grants.

437 children were given material assistance in the form of scholarstic materials, school uniforms etc. 121 children were
registered onto the waiting list during this quarter. 48 HIV positive OVCs (32 males and 16 females) were served during
this quarter.

During the month of August 2006, 2 female children (one of them on ARV) from Kinawataka service outlet enrolled onto
the program (who were RO clients themselves) died while 2 female children again from Kinawataka left the program. 3
OSF staff received some training during this quarter, some of which involved M&E modules.

Funding
The donors of Operation School Fees are categorized into two groups, private/individual and group donors. Under the
group donors we have the Uganda Bikers Association sponsoring 85 children, Sid Ecole (Schools against HIV/AIDS,
Geneva) sponsoring 80 children, Califonia ROSES sponsoring 83 children, AVSI sponsoring 197 children divided into
two groups. One of them is AVSI Reach Out -these are children of clients who get medication from Reach Out and the
second -AVSI Parish, these are children of needy parishioners identified by the Parish Priest. In addition to this, 5 new
children were enrolled and supported by the program during the last quarter.

Private/individual donors are individual persons or well wishers, who support our children. At the end of the quarter
there were 50 individual sponsors taking care of 95 children. Some children are sponsored out of the Reach Out
Programme profits that are realized through the sell of items like the Replikit, Documentaries and beads.


                                                                     20
The children under Operation School Fees programme range from nursery to senior six, one in vocational school has
dropped out.

The graph below shows the number of children according to the grades.
                          NO OF CHILDREN ACCORDING TO GRADES

                    90
                    80
   NO OF CHILDREN




                    70
                    60
                    50
                                                                                   Series1
                    40
                    30
                    20
                    10
                     0
                         Nur P.1 P.2 P.3 P.4 P.5 P.6 P.7 S.1 S.2 S.3 S.4 S.5 S.6
                                                GRADES




Roses of Mbuya-Sewing Workshop

Part of Reach Out’s Social Support Network is the ‘Roses of Mbuya’, which is a tailoring workshop offering skills-
building and employment to Reach Out clients. Products made include, clothing, wallets, bags and household
accessories. The “Roses” also undertake contract work, which is their main avenue for generation of revenue.

Under the Roses of Mbuya we also manage the Beads of Hope project which is a cottage industry where our clients
make beautiful paper bead necklaces, bracelets, anklets, earrings and other crafts in a variety of colours and designs.

During this quarter we have continued improving our record keeping system by creating a data base which keeps track
of our transanctions.. We also continue to undertake training under the Beads of Hope Project in order to build our
capacity to scale up the quality of our products.

This quarter we started following proper accounting procedures, recorded all our costs, sales, creditors and debtors in the manner
that is easily followed. We also held an exhibition to showcase the new line of products being produced under the Beads of Hope.

This quarter we have posted a net profit of approximately 10 million UgShs. This is the first quarter where we have recorded all our
costs including the overhead costs and stipends. This is a major step for the Roses and means we are on the road to self-
sufficiency.

Contracts and special orders
Roses of Mbuya has recorded sales of approx. Ugshs. 38 million and expenses for the quarter were recorded at
approx. Ugshs. 28 million. This quarter we’ve also worked on two short contracts for PSI (making filtration cloths for
HIV/AIDS kits) concurrently with our prior contract. The two new contracts are worth 11,760,000UgShs. The old
contract that will be ending next quarter is worth 28,875,000UgShs.The St. Kizito contract is also still ongoing. We have
had this contract for a few years now and it’s therefore an important line of sustainable revenue for the Roses.

Besides the above, ‘Roses’ recorded approximately 9 customized orders per quarter, mainly from regular customers
and the rest from new customers who came looking for the “Roses” thru word-of-mouth publicity.Our retail shop sales
have been quite high this quarter. We also received a good amount of money from our friends overseas that have been
selling our products for us, particularly from Denmark. We are grateful to all our development partners for the help
extended to us. We continue to look for other possible retail outlets for our products.

This quarter one of our staff attended a capacity building workshop in Monitoring and Evaluation. The skills learned will
go along way in improving the management of the workshop. Some technical training regarding patchwork making had


                                                                              21
been planned for the Roses of Mbuya in the month of April. Unfortunately we were unable to carry it out because of
lack of a teacher, it has been rescheduled for this quarter when hopefully a volunteer expected from Kenya will be
available to do it. We hope to enhance our existing product line by adding patchwork to some of the products


Program Implementation Support Department
The Programme Implementation Support department has worked hard to continue its role of enabling all of the other
departments of Reach Out to consolidate and grow in order to meet the needs of our ever-expanding client population.
Our satellite clinic in Kinawataka opened in November 2005 and has continued to avail services closer to the
community and as a result, we have seen the number of new clients grow substantially month by month.

In the Programme Implementation Support department we continue to work hard to become the strong foundation on
which all the other departments can stand and the walls to protect the program so it can grow and develop. We have
striven this Quarter to strengthen and further define our policies and procedures in regards to finances, volunteer and
employee guidelines, stock management, purchasing, and general operations.

Our team has struggled to respond positively to the new changes brought about as we all try to respond to the
expanding needs of our program. We continue to strive to help each department fully realize its potential and deepen
their abilities to serve the poor of Mbuya and enable as many as possible to have access to decent medical care. We
also try to welcome them to participate in the wide range of social services which are now offered at Reach Out Mbuya.

Monitoring & Evaluation

This quarter, the department embarked on a capacity building training workshop which was co-funded by IPH and a list
of facilitators of vast knowledge were used by RO in executing this activity. The facilitators included Dr. Samson
Kironde, from UPHOLD and other IPH fellows as well as Denis C. Businge, Dr. Stella Talisuna and Richard Omasete
from RO. Trained were all 32 participants- department heads and their deputies as well as other staff charged with over
looking data and reporting.

The section was also able to streamline reporting systems by arranging information and client file flows from reception
to all other service points. Furthermore the introduction of the ‘balanced scorecard system’ in all departments has
helped in reducing on the problem of double counting and reporting which always brings about inaccurate figures.

M&E has continued to advance data quality, databases, data collection and streamlining reporting systems as well as
increasing on technical staff capacity building.

M&E continues to be involved in generating and participating in lots of HIV/AIDS related studies in conjunction with
different partners and internationally renowned institutions.

More training is expected to be organized in the next quarter thereby making different RO technical staff realize the
importance of data collection and the role of M&E in program development. Some Operations Research activities are
also expected to be conducted over the next 2 quarters.

In a bid to have systems in place, computerized databases continue to be developed for different departments and
sections. i.e the BOL, CATTS, WFP and OSF and the viral load and pill count databases have been fully developed.

Operation Support

The Operation Support Department handles site management, buildings, security, equipments, stock management,
transport and all program computer needs. The first, second and third quarters of 2006 have been another challenge
for us to maintain our commitment of serving all departments of Reach Out with their operational needs efficiently and
effectively. As our program continues to expand, our operational needs and costs increase.



                                                          22
The new RO office building at Mbuya has been completed and occupation of space will take place during October
2006.

Human Resource
Not very many activities took place in the organisation in as far as the HR management is concerned. Recruitment,
staff identification, staff replacements, internal staff transfers, trainings, and programme restructuring activities took
place in the quarter.

There was one major recruitment of a clinical officer. Another new Staff, a Medical Officer, who had been granted
vacancy in the organisation also reported for duty mid July 2006. A temporary support staff charged with maintenance
was also recruited in RO’s Kinawataka branch. 2 more cleaners were recruited at the Reach Out headquarters. We
also got a volunteer that came in to help with the Client Registry Section (Reception). She is helping this section with its
work load and at no cost. The Kinawataka branch of Reach Out also got a Site manager, who was already heading the
Client Registry (former Reception) Section at the time of the appointment. In another related development, Dr. Namisi
Charles Patrick replaced Dr. Jason Christopher (a VSO Volunteer) whose contract with Reach Out expired towards the
end of July, as the new Reach Out medical coordinator. Doctor Samuel Guma continues to serve as the Assistant
Medical Coordinator.

Other activities going on include making of staff identification cards and program restructuring which is most likely to
take effect next quarter. The HR Coordinator is therefore working hand in hand with Mr. Owor, a Management
Consultant and member of the Reach Out board of governors. This will help in ensuring that the new structure and all
the other related functions are made with as much objectivity as possible. The revisions will also ensure that all the
various departments and sections are strengthened to help us provide more quality services. At present, only the
medical support department functions well as a unit.


Communications section

This quarter, RO had a total of 264 visitors, most notably the British High Commissioner Mr. Gordon Francois, the
British member of Parliament Mr. Jeremy Hunt, Ms. Chiaki Warner and Ms Yuko Takehara from the Japanese
Embassy. Majority of the visitors were attached to various organizations and institutions i.e. PLAN Uganda, EPN
Germany, UCSF-San Francisco, IDI-Mulago, International Hospital Kampala, TASO Uganda, Hospice Uganda, Capital
Radio, GOAL Uganda, PIDC and Bushenyi Medical center.

3 Reach Out volunteers attended a consortium of grandmothers’ meet with the Stephen Lewis Foundation (Building a
functional Community of grandmothers and their dependants – a road to meaningful and sustainable livelihood). 3 other
RO volunteers attended the XVI International AIDS Conference in Toronto- Canada.

The Communications section continues to make sales from the Reach Out educational and informative material. The
section also continues publishing the bi-weekly Reaching Out Newsletter as well as writing thank you letters to donors.
Making of 4 posters for the XVI International AIDS Conference was also accomplished during this quarter.



Finances
The Finance team continued to ensure good stewardship of Reach Out resources in the third quarter 2006. In order to keep up
with the challenges that result from the continued growth of Reach Out Mbuya, the finance team is constantly attempting to update
and improve our financial transparency. We accomplish this goal by setting up new measures and policies, at the same time
providing updating and training for our staff. In the next quarter we have scheduled an audit to measure our program. As we
prepare to move to the new Community Center (in the next few days), the Finance team has embarked on a better filling system
and together with Information Technology Section, we are working hard to computerize and upgrade all of the accounting systems.




                                                              23
Total Income
As always, we are very grateful to our donors for their generosity. The support we receive is what has empowered us to continue
serve our over 2277 active clients in Mbuya Parish. In the third quarter, the total income we received from grants and donations,
income generating activities and in kind of food from World Food Program came to Ug shillings 669,950,166 or US $ 372,194.54.
Grants and Donations came to Ug Shs 551,880,616. (US $ 306,600.34). Thanks to the PSI and others who have uplifted our
Roses of Mbuya with contracts. The total amount we received from Roses of Mbuya and our Bread of Life returned Loans, which
together are our income generating activities, came to Ug Shs. 32,567,750 (US $ 18,093.19) we also acknowledge the immense
contribution of the World Food Program food during the Second Quarter with in-kind food donations, which were valued at Ug Shs
85,501,800 (US $ 47,501.00). The costs of the ARV drugs procured this quarter came to Ug Shs 56,076,000. (US $31,153.33).

Total Income for third Quarter 2006 at Reach Out Mbuya
No         Item                                                  Total Ug Shs           Total in US $       Percentage %

1           Donations and Grants                                 551,880,616               306,600.34                82.38

2           Sales from Income generating activities                                         18,093.19                4.86
                                                                       32,567,750
3           World Food Programme (WFP)                                                      47,501.00                12.76
                                                                      85,501,800
4           Total                                                669,950,166               372,194.54               100.00

US $ 1 = Ug. Shs. 1,800


Income Generating Activities: we continued to strengthen our income generating programs. Their contribution this quarter went
up to 4.86 % of the funds we use, this gives us a sense of hope--- to be able to produce and sell our own products. We are proud
of our Roses Tailoring Workshop that has contributed a great deal to this venture. The total amount earned from the sale Reach
Out’s Roses of Mbuya shop products, DVD’s, Replikits, Calendars, CD’s, Beads of Hope, and profits from our micro-loans came to
a total of Ug. Shs. 32,567,750 (US $ 18,093,19)

Total Income for Second Quarter 2006 at Reach Out Mbuya
No         Item                                      Total Ug Shs                       Total in US $       Percentage %

1           Donations and Grants                                 551,880,616               306,600.34                 82.38

2           Sales from Income generating activities                                         18,093.19                 4.86
                                                                       32,567,750
3           World Food Program (WFP)                                                        47,501.00                 12.76
                                                                      85,501,800
4           Total                                                669,950,166               372,194.54               100.00




                                                              24
          Reach Out Mbuya Income for Third Quarter 2006
                     World Food
                     Programme
                       (WFP)
                       12.76%
              Sales from
                Income
              generating
               activities
                 4.86%


                                                 Donations and
                                                    Grants
                                                   82.38%




In the third quarter RO’s total expenditures amounted to Ugshs. 644,102,014 (US$ 357,834.45) and these fell into three
categories, namely Administrative costs, Operational costs and Capital expenditures.
The operational costs of Reach Out Mbuya in the third quarter came to a total of Ug Shs. 527,073,396 (US
$292,818.55) or 82.38% of entire program costs. In this category, we include the costs of ARV drugs, the food
supplies, all emergency food support to our weak clients, home based care items that is blankets, mattresses and
clothing for the critically ill and the weak. Also included this in this category is the stipends for clinicians, community
network of care, all testing for our clients; lab supplies costs, x-rays, training and scholarships. Also covered in this
category are our transport costs to the community clinics, home visitation of the critically ill, transportation of clients to
other treatment centers, as well as paying for materials, stipends for community workers, record-keeping, and data
entry for all the departments such as community education, adult literacy, micro-finance, youth work, behavior change,
and food distribution. We are especially thankful to the World Food Programme for their generous support, the food the
clients receive help the medicines to take effect.

Costs for the administrative and support costs of Reach Out Mbuya’s program came to Ug Shs. 54,786,618 (US $
30,578.89) or 8.51% % of total costs. In this quarter of the financial year, we kept the administrative costs as low as
possible. We used the funds in this category for the salaries of our administrative team, office supplies, and computer
supplies, costs of Internet, phone, and postage. In addition we have also used the funds to insure good security both at
our center and satellite clinics.

As our Community center at Mbuya comes to completion, our capital expenditure were lower in this the third quarter.
The total costs of our building projects came to Ug. Shs. 62,242,000 (US $ 34,578.89) in the months of July to
September 2006. Capital expenditures came to 26.35% of our total budget. We appreciate the generous contributions
of our friends and donors; these among others are: Concern Uganda, the Stephen Lewis Foundation, Gary and Joni
Jones, and our Directors Fr. Joseph Archetti and Dr. Margrethe Juncker, who donated her entire salary to help
complete our building.

Total Expenditures Third Quarter 2006 at Reach Out Mbuya
US $ 1 = Ug. Shs. 1,800
No.        Item                                       Total in Ug. Shs                Total in US. $     Percentage %
1          Operational Cost                           527,073,396                       292,818.55                  81.83
2          Administration Cost                                                           30,437.01
                                                           54,786,618                                   8.51
3          Capital Expenditures                       62,242,000                          34,578.89                    9.66
           TOTAL                                      644,102,014                        357,834.45               100.00




                                                             25
                  Reach Out Mbuya Expenditure for the Third Quarter

                               Capital
                             Expenditures
                                9.66%
                 Administration Cost
                      8.51%



                                                      Operational Cost
                                                          81.83%




This quarter has been a time of hope and prosperity. Work has already started in another community clinic at Banda.
We are very aware that without the faithful and generous support of our donors both individual and groups---we could
not have advanced as far as we have and we have begun to see our dreams become realities.

General achievements, Challenges & Future Prospects
    Achievements
    • The Reach Out new office block at Mbuya has been completed and we are yet to sign a MOU with the
       Japanese embassy on the construction of a community centre at Acholi quarters. We have managed to
       increase on the numbers of children seeking for VCT and this quarter we had a total of 211 children testing
       and receiving results.
    • Though the finding this quarter of 84.1% of RO clients adhering at above the WHO 95% level was lower than
       that of 89.9% last quarter, the project has managed to maintain high drug adherence levels through the
       CATTS and TIU sections of community and medical support respectively.
    • RO’s food and nutritional aid program has managed to phase out about 316 clients from the food list and this
       was because these clients have been helped by RO in building their own personal health and the capacity to
       work on their own and be able to sustain their lives. There has also been an improved quality of life on all
       clients especially those who are enrolled on ART as their CD4 counts have increased.
    • RO has managed to increase on the amount of money generated from its IGAs mainly from the Roses of
       Mbuya program
    • 32 of Reach Out’s staff from various departments were trained in a 5 days training course which centered
       around the use of M&E in the development of programs. The course mainly focused on making participants
       appreciate the role of data collection and its utilization.
    • In August, the first set of 6 trainees on the comprehensive HIV care course completed their 3 months of class
       sessions and joined the clinic team for full time clinical rotation.
    • Of the 19 babies born during this quarter, 11 babies have been tested for HIV and 10 were found negative an
       indication that our PMTCT program is working.

Challenges & remedies
   • Load shedding for hydroelectric power that is currently experienced countrywide has prompted increased use
        of the generator for more than 3 days in week and the fuel costs for running it remains a constant challenge.
   • Though our loss to follow up remains low compared to other programs in the country, it still remains a
        challenge. Some clients are never at their homes when routine HBC is being provided and neither do they
        bother to attend their clinic appointments and they sometimes resurface for clinical attention when they are ill.
   • Our clients/borrowers have no collateral security and this has poised the highest risk to loan recovery. Most
        loan clients are also illiterate and thus can’t keep book records. However we have always encouraged them to
        attend our RO adult literacy classes and entrepreneurship training. Some of our clients on the loan program
        have been lost to follow up or have died.
   • The current comprehensive HIV care course has kept all the clinicians busy and yet the same clinicians need
        to attend to clients. Dividing up time between clinic and class remains a challenge.


                                                          26
    •    Some of our clients are being evicted from their homes in big numbers especially those who around Middle
         East Bugolobi as the local councils are destroying the slums to pave way for development. This is increasing
         our loss to follow up numbers.


Recommendations

This quarter has managed to exhibit growth within Reach Out and its service outlets. It’s now time to consolidate Reach
Out’s achievements and this can be done mainly through the scaling up of the family based approach which was
started in March 2006. This will help not only to look at an individual client but also their family so that holistic care is
provided to the entire family.




                                                            27
Annexes
Annex 1

List of Acronyms


ARVs          Anti Retrovirals
HIV           Human Immunodeficiency Virus
AIDS          Acquired Immune Deficiency Syndrome
MTCT          Mother to Child Transmission of HIV
PMTCT         Prevention of mother To Child Transmission of HIV
DNA-PCR       Dioxynibo Nucleic Acid ― Polymerase Chain Reaction
WHO           World Health Organization
WFP           World Food Program
ELISA         Enzyme Linked Immuno Sorbet Assay
ARV           Anti Retro Viral Therapy
MOH           Ministry Of Health
BOL           Bread of Life
CATTS         Community ARVs and TB Treatment Supporters
CHCT          Couple HIV Counseling and Testing
TB            Tuberculosis
JCRC          Joint Clinical Research Centre
CDC           Center for Disease Control
IDI           Infectious Disease Institute
PTB           Pulmonary Tuberculosis
EPTB          Extra Pulmonary Tuberculosis
OSF           Operation School Fees
IPH           Institute of Public Health
PEPFAR        Presidential Emergency Plan for Aids Relief
LQAS          Lot Quality Assurance Sampling




                                                     28
Annex 2
Table: Clients counseled, tested and received results by gender and age group.

           Age-Group                   HIV test results
           (years                                                                        Quarterly
                           Sex         April              May           June
           unless                                                                        Totals
           specified)
                                       -       +          -     +       -        +       -       +
                           Males       0       1          2     0       1        0       3       1
           < 24∗ months    Female0     1       0          2     1       1        1       4       2
                           +-*-s
           24-               Males     11      0          9     1       2        0       22       1
           59∗months       Females     7       1          3     1       3        1       13       3
                           Males       14      3          10    5       5        4       29       12
           5-9∗
                           Females     11      6          7     3       24       2       42       11
                           Males       7       0          9     4       6        2       22       6
           10-14
                           Females     7       3          8     2       11       1       26       6
                           Males       1       0          1     0       2        0       4        0
           15-17
                           Females     1       0          5     0       2        0       8        0
                           Males       0       3          2     0       0        0       2        3
           18-19
                           Females     8       5          5     1       3        1       16       7
                           Males       11      1          15    0       10       0       36       1
           20-24
                           Females     25      11         21    10      13       6       59       27
                           Males       30      22         44    15      41       25      115      62
           25-35
                           Females     31      24         37    26      28       40      96       93
           36-49           Males       22      14         19    15      14       13      55       42
                           Females     17      16         17    21      17       18      51       55
           50-54           Males       1       2          5     2       1        0       7        4
                           Females     2       1          3     1       3        1       8        3
           55+             Males       1       1          5     0       2        1       8        2
                           Females     2       1          0     2       1        5       3        8
                           Males       98      47         121   42      84       45      297      134
           Totals
                           Females     112     64         111   67      109      75      332      215




∗ The primary care takers for female children <10 years are the ones counseled on how to raise these children and
the children themselves are tested for HIV



                                                          29
Prophylaxis continues to rise due to the increase of clients, the drugs dispensed by months at each site are shown below in table No.3
Table No.3
Name       Of
Drug             Mbuya                                        Total         Kinawataka                          Total        Banda                        To
                 July             August        Sept                        July      August        Sept                     July        August   Sept
Cotrimoxazole 39640               44728         27458         111826        45874     142550        54291       242715       13876       12375    13708   399
Vitamin      B
Complex          39804            45643         27877         113324        45915     68008         51177       165100       14273       13600    13754   416
Panadol          15400            18377         11142         44919         76294     29192         15977       121463       6080        5940     6166    181

Doxycycline prescription has improved compared to the previous quarter as shown in table No.4 and No.5 below
Table No.4 showing amount dispensed in 2nd quarter
Name        of
Drug            April            May        June         Total
Doxycycline     4558             4106       3232         11896

Table No.5 showing amounts dispensed and the sites
Name        of
Drug           Mbuya                               Total                 Kinawataka                            Total        Banda                         To
               July         August      Sept                             July     August           Sept                     July         August   Sept
Doxycycline    1508         1578        876        3962                  2054     3160             2460        7674         500          890      570     196

Amoxacillin caps prescription continues to rise compare table No.6 for 2nd quarter and table No.7 for 3rd quarter
Table No.6 for 2nd quarter
Name        of
Drug             April           May             June
Amoxacillin      2976            2926            4364

Table No.7 for 3rd quarter
Name        of
Drug             Mbuya                                     Total         Kinawataka                            Total        Banda                         To
                 July            August         Sept                     July     August           Sept                     July         August   Sept
Amoxacillin      1369            1722           1071       4162          1535     4237             4987        10759        1203         600      654     245

                 Source: Information from the Pharmacy




                                                                                 30

								
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