[CONTINUING ACTIVITY FROM FY2006 -- NO NEW FUNDING IN FY2007] This activity relates to AHA actitivies under CT (#4874) and BHC (#4873).

Over 50,000 refugees live in camps across Rwanda. AHA provides support to a total of about 17,000 refugees in Kiziba refugee camp in Kibuye District. AHA, UNHCR and other agencies support ongoing efforts for HIV prevention, care and treatment services in partnership with Kibuye District Hospital. CAPACITY/IntraHealth will be supporting VCT and PMTCT in collaboration with AHA in FY05. GLIA will also support HIV/AIDS services in Kiziba Camp starting in FY2006 with a limited amount of funding. All EP activities will be coordinated with GLIA to ensure complementarities and non-duplication of services. AHA will reach 900 pregnant women, including 30 HIV+ women and their infants in the Kiziba refugee camp, through the provision of a comprehensive package of PMTCT services, including a revised CT strategy to include opt-out CT for ANC women, ARV prophylaxis using an expanded bi-therapy regimen, IF counseling and support, and provision or referral for FP and MCH services. Test kits will be procured through RPM-plus.

AHA will support on-the-job and refresher training of health center camp providers on the expanded PMTCT ARV regimen and mother-infant follow-up and support. Health center staff will support and monitor use of the new regimen through existing national checklists and algorithms, routine data collection, laboratory monitoring, and supervision of providers. AHA will also monitor provider performance through ongoing supervision and QA activities, and will strengthen capacity of refugee camp providers in M&E, including routine data collection, use of data for PMTCT program improvement, and reporting within the national reporting system. Linking HIV to other MCH and RH services, AHA will integrate its existing safe motherhood and FP activities into the PMTCT program. AHA will integrate the national IF counseling tools and guidelines developed by UNICEF and TRAC, establish adequate mechanisms to monitor IF practices among HIV+ women, and leverage food support for weaned infants. Using existing tools and curricula, AHA will incorporate GBV training for refugee camp health providers, lay counselors, and community groups to mitigate the risk for GBV in the refugee camps and ensure appropriate provision of, or referral for, GBV and trauma counseling for female victims of violence. Refugee camp health center staff will use screening tools to assist in identifying potential victims of violence.

To ensure appropriate follow-up care and support for HIV-positive mother-infant pairs and their families, AHA will support the network model through the establishment of systematic and formalized referral systems within the camp health center, with other clinical partners in the surrounding catchment area (Columbia MCAP and Intrahealth at Kibuye DH or other health facilities in the district), and with refugee community-based services. This will include provision of, or referral for, systematic CD4 testing, ART, TB screening, diagnosis, and treatment; management of OIs and other HIV-related illnesses; PCR and PT CTX for exposed infants. AHA will also ensure referral of PMTCT clients and their families to HBC services, OVC support programs, PLWHA Associations, IGA, and facility- and community-based MCH services promoting key preventive interventions such as bednets, immunizations, hygiene/safe drinking water and nutritional support. Refugee camp services will take advantage of these networks of refugee community leaders, TBAs, refugee women's groups and PLWHA Associations to promote services and messages that focus on stigma reduction, infant testing, GBV reduction, male partner testing, infant feeding promotion and promotion of HIV care and treatment services, and to assist in the monitoring and tracking of pregnant and postpartum HIV-positive women and their infants, particularly OVC.

[CONTINUING ACTIVITY FROM FY2006 -- NO NEW FUNDING IN FY2007] This activity relates to PMTCT (#4871) and CT (#4874).

Currently, over 50,000 refugees live in camps around the country. AHA provides support to a total of about 17,000 refugees in Kiziba refugee camp in Kibuye District. AHA, UNHCR and other agencies have supported ongoing efforts for HIV education and clinical services in partnership with Kibuye District Hospital. In collaboration with AHA, CAPACITY/IntraHealth will support CT and PMTCT services in FY2005. GLIA will also begin supporting HIV/AIDS services in Kiziba Camp starting in FY2006 with a limited amount of funding. All USG EP activities in Kiziba will coordinate with GLIA to ensure complementarity and non-duplication of activities.

In line with the USG EP vision and standard package of care to be provided by all USG EP partners, funding for this activity will support the provision of basic palliative care to 500 PLWHA and the training of 25 health providers in the Kiziba refugee camp health clinic. The basic care package will include provision of or referrals for prevention, diagnosis and treatment of OIs and other HIV-related illnesses, including TB; routine clinical staging and systematic CD4 testing, creation of medical records for all HIV-positive patients; prevention counseling for positives; nutritional assessment and counseling, and leveraging of food for malnourished PLWHA (particularly for pregnant and lactating women and exposed and infected infants); and active and comprehensive referrals to community-based psycho-social and palliative care services. Infants born to HIV-positive mothers will be provided CTX PT, early infant diagnosis through PCR DBS, and ongoing clinical monitoring and staging for ART. Palliative care drugs will be procured through RPM-plus.

In collaboration with MCAP, AHA will work with the Kibuye DHT to ensure that Kiziba health center providers receive training in basic management of PLWHA, including training in ART adherence support, and in the identification and management of pediatric HIV. AHA will monitor and evaluate HBHC activities through ongoing supervision, QA, and data quality controls, and will build the capacity of local refugee health care providers to monitor and evaluate HIV/AIDS basic care activities through ongoing coaching and strengthening of routine data collection and data analyses for basic care.

AHA will support the network model through the establishment of referral and tracking systems for comprehensive basic care and support services for PLWHA. AHA will work with existing partners at Kibuye District Hospital (ART supported by Columbia MCAP) to strengthen and formalize the referral system between the camps and ART and other HIV care and support services, such as transport of blood specimen CD4 and PCR testing, management of complicated OIs, and periodic monitoring of ART patients. AHA will also link with community services and counselors in the camps, including community and spiritual leaders, refugee PLWHA association members, and social workers to ensure access to community-based clinical and psychosocial support for HIV-positive refugees and their families. This will include referrals for GBV and trauma counseling for HIV-positive women, prevention counseling for positive and discordant couples, HBC and OVC support, ART and TB adherence counseling, and spiritual support. AHA will also ensure provision or referrals for other forms of palliative care activities in the camps including IGA, microfinance, wrap around for food support, and will train peer counselors and volunteers on home based care, as well as PLWHA in self-care and positive living, with special attention to refugee widows and their children, refugee OVC and other vulnerable refugee populations.

[CONTINUING ACTIVITY FROM FY2006 - NO NEW FUNDING IN FY2007][

This activity relates to Activities AHA HBHC (#4873) and AHA PMTCT (#4871).

There are over 50,000 refugees living in camps around the country. AHA provides support to a total of about 15,000 refugees in Kiziba Camp in Kibuye Province. AHA, UNHCR and other agencies working in refugee camps have supported ongoing efforts for HIV education, supplemental nutrition for PLWHA, CT, and some ARV treatment in partnership Kibuye District Hospital. In collaboration with AHA, CAPACITY/IntraHealth will support CT and PMTCT in FY2005. GLIA will also begin supporting HIV/AIDS services in Kiziba Camp starting in FY06 with a limited amount of funding. All USG EP activities will need to be coordinated with GLIA to ensure complementarity and non-duplication of services. Priorities as stated in the EP five-year strategy aim to deliver high quality CT services, linking CT clients with other HIV prevention, care and treatment services.

The Kiziba camp health facility sees between 150-200 outpatients every day, including TB and STI patients, and malnourished adults and children. Through this funding AHA will support the continuation of existing CT activities in Kiziba refugee camp to reach 5000 refugees and train 25 health care providers. Rapid test kits will be procured through another partner. Given the high volume of outpatients, AHA will integrate routine PIT with informed consent into all its health center activities with particular attention to reaching TB and STI patients, patients presenting with HIV-related symptoms and illnesses, HIV-exposed infants and patients receiving care in the therapeutic feeding centers. AHA will target 30-40% of all those tested through PIT, and will continue to ensure the availability of traditional VCT, particularly for partners and youth. AHA will also integrate CT into FP activities to offer routine CT to FP clients. AHA will also target partners and family members of identified HIV-positives, as well as widows and widowers, for testing through outreach testing activities and campaigns, utilizing refugee groups, refugee community leaders, and refugee PLWHA Association activities. AHA will

AHA will train existing and new staff in PIT with informed consent, as well as in counseling for youth, male partners, and other high risk populations in refugee camp settings. AHA will emphasize counseling in partner reduction, GBV and alcohol reduction to sensitize clients to issues related to GBV, stigma, and confront social norms. CT providers will be trained in GBV and trauma counseling for women, particularly for HIV-positive and negative women and widows who may be victims of violence. AHA will use CT curriculum and tools that already exist for these populations and adapt them as necessary. Where curriculum and tools are lacking AHA will develop and integrate as necessary. To reduce the burden on existing health staff, lay counselors, refugee camp PLWHA association members, and other non-health professionals will be utilized to support CT activities at the health facility level under supervision of nursing or other health center staff. To ensure quality CT service delivery, AHA will provide supportive supervision of CT staff through QA, monitoring provider performance, and data quality reviews. AHA will also strengthen the capacity of refugee health care providers to monitor and evaluate CT services, including supervision, routine data collection, use of data for program improvement, QA methods, and reporting of data within the national system.

AHA will also support the network model by ensuring routine referral for comprehensive care and support services, including CTX screening and PT; TB screening, diagnosis and treatment; management of other OIs and related HIV-illnesses; CD4 count testing; PCR testing and CTX PT for exposed infants; ART referral and support; nutritional counseling and support; and other psychosocial support services, either on site or at nearby health facilities. In collaboration with Columbia, Intrahealth, FHI and other partners at health facilities surrounding the camp, AHA will develop referral plans for services not offered on site. AHA will also work with RRP+ to support the existing PLWHA groups and the formation of new PLWHA groups. Where community services exist, establish a system of referral for HIV-positive patients for community-based services, such as IGA, PLHA associations, OVC, spiritual support, community-based GBV and trauma counseling, HBC programs. AHA will work with these groups and the health facility ensure appropriate follow-up through development of referral, tracking and monitoring tools and registers.

Using existing resources in the camp, AHA will support the promotion of CT services to refugee populations through interpersonal communication activities, utilization of PLWHA

support groups, refugee committee leaders, and women's groups. Messages will include stigma reduction, gender based violence sensitization, promotion of CT, and utilization of HIV/AIDS care and treatment services. AHA will target men and youth to sensitize clients to issues related to GBV and stigma, and confront social norms that promote acceptance of GBV and cross-generation and transactional sex.