The Supply Chain Management System will procure and distribute essential medicines and health supplies. It will also work to strengthen existing supply chains in the field and facilitate collaboration and the exchange of information among key donors and other health providers. This activity contributes to the GHI Burundi goal which is Improved Health of the Burundian population, especially for girls and women.

The SCMS activity is a support service for the provision of HIV/AIDS prevention, care and support services. This activity will cover especially the eight provinces supported by PEPFAR and will procure and distribute the medical supplies in the eight provinces. Additionally, the strengthening of the supply chain will target the national level. The activitys targets are the general population, pregnant women and their partners, people living with HIV/AIDS (PLWHA), orphans of AIDS and other vulnerable children, youth, low-income women and most- at- risk populations (MARPs).

To be more efficient, the SCMS activity will pool procurements with other countries so that unit prices can be reduced. As already stated above, one of SCM tasks is to strengthen the capacity of the national supply chain, the ultimate goal being to work through the Burundi national supply chain system for more sustainability and country ownership.

For the tracking of the progress, custom indicators will be established by the USG team in Bujumbura in collaboration with SCMS.

This activity will be jointly executed by FHI 360 and SCMS. The FHI 360 service delivery activity will support local organizations to expand basic care and support services for PLWHA. Home-based care was provided to 11,100 individuals, including monthly psychosocial support visits provided through community health workers (CHWs) based in all the communes of Karusi, Kayanza, Muyinga and Kirundo provinces in 2011. In 2012, FHI will continue to support current activities for PLWHA with home-based care services. Additionally, CHWs will deliver a package that includes psychosocial support, health-care and hospitalization assistance, hygiene products, pain relievers and information on sexual prevention and testing. One of the key roles of the CHWs will be to ensure that PLWHAs whose health continues to decline are accompanied to a health facility for further care. Cotrimoxazole prophylaxis against opportunist infection will continue to be supported in all health clinics located in the four targeted provinces. In 2012, its expected that 28,630 adult and children be provided with a minimum of one care service.

FHI funding will complement work supported by the GOB and other development partners in selected provinces. While USG provides no programming addressing HIV/TB co-infection, FHI will collaborate with the Global Fund, Damien Foundation, and Belgian Technical Cooperation, which are supporting the national TB and HIV/TB co-infection programs. During TC for HIV, clients will be screened for common signs of TB. Clients who present with symptoms will be referred to TB centers. The same test-and-referral approach will be adopted for TB patients.

The specific role of SCMS will be the purchase of pain relievers, cotrimoxazole for the prevention of opportunistic infections, and clean water devices. In addition, once the people living with HIV/AIDS need biological follow-up and PMTCT services, they will use the products purchased and managed by SCMS.

The Directorate of Pharmacies, Medicines, and Laboratories (DPML) is the division of the Ministry of Public Health (MOPH) charged with the responsibility of providing oversight to the pharmaceutical sector. The DPML oversees the central purchasing and warehousing agency, Centrale dAchat de Médicaments Essentiels du Burundi (CAMEBU). Procurement and management of all public sector pharmaceuticals (both government and faith-based) is the responsibility of CAMEBU. The Permanent Executive Secretariat of the National Council to Fight against AIDS oversees the quantification and identification of ARV needs for Burundi as well as other HIV/AIDS related products.

Some assessments and audits have been conducted by the USG (through the malaria program) and development partners on the Burundian pharmaceutical management and supply chain system. To build on the past recommendations and findings for the supply chain system, the USG has requested Supply Chain Management Systems (SCMS) to support Burundi in addressing supply chain design, performance, and planning in order to support the HIV/AIDS program. In December 2011, SCMS conducted an initial assessment of the supply chain system and process analysis. The assessment report provided recommendations on what activities should be implemented to improve the supply chain in Burundi. The proposed activities intend to ensure uninterrupted access to essential HIV/AIDS. They include among others:

Creation of written procedures for the control and supervision of medical prescriptions;

Training for the logisticians on the correct use of the district manual of procedures;

Ensuring feedback after each training;

Applying good definition of logistical tasks at the health facility level;

Provision of written procedures for transportation of medical products;

Ensuring that all overstocked products are distributed to other out-of-stock sites;

Organization of regular discussion forums between medical prescribers and the organisation responsible for ordering stock;

Correct usage of the quantification formula used during the forecasting process;

Implementation of national logistic management information system to facilitate the gathering of accurate consumption data from all the health facilities.

SCMS will be complementing the services provided by FHI 360. In FY 2011, FHI 360 continued to support sub partners to provide quality and confidential HTC services in accordance with the national protocol. Thus, 137,913 individuals were tested for HIV and 134,866 of them received their test results. In FY 12, FHI 360 service delivery activities will continue to extend HTC services in the provinces of Kayanza, Karusi, Muyinga, and Kirundo. The target population will be the high risk groups who circulate in those provinces and the communities in high transmission areas in those provinces. The target groups include truck drivers and their assistants, sex workers, general population, low income women, men and other community members. In 2012, it is expected that 220,602 individuals will receive testing and counseling services for HIV and get their test results. HIV CT will also be extended to STI and TB patients. The following strategies will be used to reach the target populations:

a. Training health providers in HTC. Training will be based on the national guidelines with special attention to improving counseling skills for clients who test positive, discordant couples, and identifying and counseling HTC clients with hazardous drinking behavior;

b. Actively promoting testing to all family members where the index patient is found to be positive;

c. Widely promoting provider-initiated testing and counseling. Interventions will emphasize couples counseling and testing among MARPs (truckers, PLWHA, sex workers);

d. Collaborating with partners to increase referral to HTC services. All STI clients will systematically be counseled for HCT; and

e. Continuing support for PBF for the following HCT indicator: Number of people tested for HIV.

SCMS will be in charge of purchasing rapid HIV test kits, laboratory equipment, and reagents and will also jointly monitor with FHI 360 the use of the products.

The activity will be jointly implemented by FHI 360 and SCMS. To reduce sexual transmission of HIV, the FHI 360 and other partners will implement evidence-based communication and small-group/individual interpersonal interventions especially targeting CSWs, long distance drivers and their assistants. To facilitate and sustain behavior change, the FHI 360 service delivery activities will strengthen peer education. Peer educators will implement messages that promote behavior change, increase access to condoms, counseling and testing services, SGBV, and alcohol consumption. The FHI 360 activities will also facilitate HIV prevention through positive behavior by working with the PLHIV association and by focusing interventions on the household unit.

The recreation center based in Bujumburas main parking yard will be selected as a preferred location to reach long distance drivers using the north and the east corridors to reach Uganda, Rwanda, Tanzania, and Kenya. Condoms will be made available in the Bujumbura recreation Center and the FHI 360 service delivery activity will continue to refer users to other services such as HTC, ART, and preventive therapy against opportunistic infections. In FY 12, it is expected that 3,550 MARPs will be reached with individual and/or small group level HIV Interventions that are based on evidence and /or meet minimum standards required.

In addition, activities will include BCC targeting young girls and family communication, use of post-exposure prophylaxis (PEP) kits for health centers, and training to ensure that CHWs, teachers, and health workers are capable of screening for and addressing risks for GBV, including providing or referring GBV victims for PEP, care, and legal services. As part of a new USG initiative in country, FHI 360 partner with another USG funded partner to begin a longer-range initiative to address social and gender norms conducive to GBV and high-risk behavior by collaborating with the Ministries of National Solidarity, Repatriation of Refugees, National Reconstruction and Social Reintegration, and of Justice and Keeper of the Seals as well as relevant CSOs, religious leaders, and womens associations, to develop a strategy for BCC, advocacy, and policy analysis and reform.

The contribution of SCMS will be focused on purchasing rapid HIV test kits, condoms and lubricants, and the drugs for sexually transmitted infections for the most-at-risk populations.

The activity will be jointly implemented by FHI 360 and SCMS. In 2011 PMTCT services were provided in 82 health facilities in four provinces, reaching 76,561 pregnant women who attended the first ANC visit, 51,077 were tested for HIV and 49,568 (97%) received their test results. Antiretroviral prophylaxis was administered to 431 (72%) out of 595 HIV positive pregnant women identified.

In FY 2012, FHI 360 will continue to provide service delivery support to strengthen 136 existing outlets and will enroll 15 new sites in the 4 supported provinces with a high-quality PMTCT minimum package. The package includes: (1) routine ANC services, (2) screening for syphilis, (3) counseling and testing for HIV, (3) accurate information on infant feeding, (4) a complete course of ART prophylaxis to HIV positive mothers and their babies, (5) mother and child follow-up, (6) and preventive therapy using cotrimoxazole prophylaxis to infants exposed to HIV. In collaboration with the MOH, FHIs service delivery activities will ensure that infants born to HIV positive mothers are tested for HIV at six weeks using dry blood spot/polymerase reaction chain (DBS/PCR). Nutritional support will continue to be provided to the most vulnerable women. To improve the uptake of PMTCT services, the following activities will be implemented:

? An assessment of the new sites to determine needs. Funds will be made available to respond to the identified needs and to ensure confidentiality, comfort and functionality;

? Training health providers in collaboration with MOH and other partners by organizing in-service training for new staff and refresher trainings for health care providers based on the weaknesses identified by supervisions. The trainings will include the HIV/AIDS epidemiological situation globally and in Burundi, the pathology of HIV/AIDS, how HIV is transmitted from mother to infant, how to provide TC, specific interventions for PMTCT (including the national protocol for clinical services), infant and child nutrition in the context of HIV infection, stigma and discrimination linked to HIV, mother-child follow-up, support for PLWHA (including sexual prevention, family planning, and partner reduction), and prevention of counselor burnout/fatigue;

? Mobilizing the community through the network of PLWHA network (RBP+), to promote couple counseling and testing;

? Developing appropriate IEC materials in Kirundi for clients and community members;

? Continuing the support for PBF for the PMTCT indicators: Number of HIV-positive pregnant women provided with antiretroviral prophylaxis and number of newborns from HIV-positive mothers provided follow-up care, ARVs to new born.

The specific contribution of SCMS will be the purchase of rapid HIV test kits, laboratory equipment, reagents, and ARVs for PMTCT prophylaxis as well as their management.

The combination of the above described activities will target an estimated 90,602 pregnant women with known HIV status be tested for HIV and receive their results. Ninety six percent (96%) of the HIV+ pregnant women will receive ARVs to reduce risk of mother to child transmission.

As already mentioned above, PEPFAR in Burundi will not be buying ARVs except those for PMTCT prophylaxis. However, given the high prevalence of sexual assaults, PEPFAR program proposed to buy a small quantity of ARVs for the survivors of sexual violence. In FY 2011, 293 survivors have been supported by the PEPFAR program. 87% of the beneficiaries were classified post-exposure prophylaxis (PEP) and unprotected occasional sex. In FY 2012, PEPFAR is planning to support 350 individuals for PEP.

The PEPFAR program in Burundi will not support any direct ART provision. The USG strategy will be to wrap critical technical assistance and procurements around existing adult and pediatric ART programs supported by the GOB, Global Fund, and others. Technical assistance will focus on improving the quality of adult and pediatric ART services, such as enhancing clinical and laboratory monitoring and improving the ability of clinical providers to identify treatment failure and ensure appropriate switches to second-line regimens. Procurement of medications will enable health providers in intervention provinces to treat opportunistic infections and STIs. In addition, the USG will continue to procure reagents for testing, laboratory equipment (including for biochemistry and hematology), and lab reagents for biological monitoring.

Since 2007, collaboration with the Global Fund resulted in providing ARVs and other essential commodities to FHI to support service delivery activities at six ART sites. By September 30, 2011, Global Fund and PEPFAR were supporting 3,757 patients on ARVs. In FY 2012, the FHI will continue to support medical doctors in the following hospitals: Kayanza, Kirundo, Mukenke, Muyinga and Musema. The physicians main role will be to provide technical support and promote ART decentralization at specific identified health centers in accordance with the national ART guidelines. For this purpose, FHI 360 will train nurses and social workers in the aspects of clinical care for adults living with HIV in order to significantly engage the health centers in day-to-day care and follow-up of patients under the first line of ART regimen. In addition, according to the needs identified during the assessment, lab equipment, reagents and supplies will be provided by SCMS to ensure that basic haematological and biochemistry tests are conducted at the health facility level whenever possible. To reinforce adherence among enrolled patients on ART, service delivery activities will continue supporting the PBF for the following ART indicator: Number of ART patients monitored semi-annually.

SCMs will contribute in purchasing laboratory equipment including hematology and biochemistry machines as well as the reagents for CD4 count, hematology, and biochemistry reagents.