[CONTINUING ACTIVITY FROM FY 2006 -- NO NEW FUNDING IN FY 2007]

PSI will engage in direct BCC activities that promote Abstinence and Fidelity and discourage alcohol abuse and GBV through its mobile CT program. This activity will address key behavioral issues among high-risk populations through print materials, mobile video screenings, and interpersonal communications. Through mobile CT events and local Rwandan subgrantees, this activity will disseminate ABC messages that focus on abstinence and fidelity to high-risk populations - prisoners, police, mobile populations and CSWs. This program supports the Rwanda EP five-year strategy by implementing an aggressive prevention education campaign aimed at prisoners. Rwanda continues to release thousands of prisoners whose HIV status is unknown. While the HIV prevalence rate in prisons remains unknown, the GOR expressed concern that it is higher than among the general population. PSI will continue serving on the CNLS-led Prisoners Steering Committee to ensure that the proper protocols and procedures are followed in the prisons.

PSI will reproduce IEC materials developed in their FY 2005 Alcohol Awareness and Fidelity campaign and revise their counselor training curriculum to include appropriate HIV prevention messages on abstinence and being faithful, as well as the links between alcohol use, violence and HIV. The program will train 10 counselors with this revised curriculum. In addition to the PSI-developed IEC materials, this activity will distribute and use AB brochures and tools developed through CHAMP. These IEC materials will be disseminated during outreach mobile CT as well as through Rwandan CBOs such as SWAA, that will be promoting CT and creating post-test clubs. Post-test clubs will be established at the community level to follow-up on referrals, provide care and support to clients who test HIV positive, and to promote behavior change and prevention (AB) among both HIV positive and negative clients. Gender-specific approaches will be integrated into CT promotion, IEC materials, and post-test clubs. All messages and materials will be developed in partnership with CNLS' BCC Steering Committee, TRAC and CHAMP for central-level coordination. In FY 2006, PSI plans to reach 20,000 high-risk individuals with ABC messages; these targets appear under Other Prevention, Activity #4877.

[CONTINUING ACTIVITY FROM FY 2006 -- NO NEW FUNDING IN FY 2007] This activity relates to PSI's Mobile CT (#4880) and AB (#4878) activities, the TCI OP activity (#4777) and the condom procurement (#4876).

In FY 2006, PSI will implement BCC activities by promoting the ABC approach through its nation-wide mobile CT program. This prevention activity will address behavioral issues among high-risk populations through IEC print materials, mobile video screenings, and interpersonal communications. Through mobile CT and local subgrantees, this activity will disseminate appropriate messages of abstinence, fidelity and proper condom use to high-risk populations, mainly prisoners, police, and CSW. The program will to use two mobile rapid HIV testing units 15 days a month. Through these community and workplace testing events, 20,000 individuals will receive direct ABC messages through video screenings and group discussions facilitated by a PSI staff person. Of these individuals, an estimated 4,620 individuals will receive further ABC information during their pre- and post- test counseling session. Individuals testing positive will receive specific information on how to avoid transmitting HIV to others. They will be urged to inform and encourage their spouses and partners to be tested. PSI will revise its counselor CT training curriculum to include appropriate ABC prevention messages and to emphasize the links between alcohol use, GBV and HIV transmission. The program will train and supervise 10 CT counselors in the use of the new curriculum. This program will provide sub grants to SWAA and several local CSW Associations to establish post-test clubs to follow up on referrals, provide care and support to PLWHAs and promote behavior change among both HIV positive and HIV negative clients. Gender specific approaches will be integrated into CT promotion, IEC materials, and post-test clubs. All messages and materials will be developed with the CNLS' BCC Steering Committee, TRAC and CHAMP to ensure central-level coordination.

Under Other Prevention funding, PSI will use $200,000 to distribute and promote condom use among most-at-risk populations at mobile CT sites, in high HIV transmission areas, and in current CT facilities funded by EP and the Global Fund. Using a social marketing approach, PSI will increase availability and accessibility of condoms through the creation of condom outlets for high-risk populations, community-based distribution of condoms, and the promotion of condoms through mid-level media such as mobile video screenings, condom demonstration, interpersonal communications and promotional materials at the points-of-sale to increase visibility. This program will use the results of the PLACE Study (2005) and the National Condom Accessibility Study (2005) to identify 10 high-transmission areas. Evidence from initial data analysis reveals that towns with high concentrations of bars, motels and small kiosks selling alcohol and fast-moving consumer goods, are particular high-risk zones. The criteria for identifying the 10 "hotspot" areas are high HIV prevalence (information available through TRAC); low condom accessibility and/or knowledge of accessibility; and high levels of unprotected sexual activity, transactional and commercial sex (BSS, 2005). PSI's Measure Access and Performance methodology will be used to identify zones with the highest rates of risk behavior and to track all commercial high-risk outlets and BCC communications. PSI/Rwanda will establish at least condom outlets for high-risk populations in each "hotspot" zone, reaching a total of 100 "hotspot" outlets. As part of the mobile CT program, PSI will create a minimum of 100 condom outlets for high-risk populations within the catchment areas of the targeted prisons, police academies, and CSW zones where PSI provides mobile CT services and peer education. This program will establish at least five condom outlets for high-risk populations in each CT target site. PSI will also use community-based distribution agents among the most-at-risk target groups during the mobile CT weeks to promote correct and consistent condom use among the CT clients and to inform them where the nearest condom outlets are located. This program will also establish condom outlets within at least 50 EP and Global Fund-supported health facilities, provide condoms to the TCI, and educate CT personnel on how to demonstrate correct condom use. This activity supports the National Prevention Plan and the Rwanda EP five-year strategy by targeting high-risk groups with ABC messages.

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

This activity relates to PSI's activities under AB (#4878) and OP (#4877).

PSI will build upon its mobile CT experience with prisoners and the military to expand community-based CT promotion and service delivery on a national scale. PSI will use its existing CT mobile testing vehicle along with one new additional vehicle to provide CT services and ABC prevention messages to the following most-at-risk populations: commercial sex workers, prisoners, and national police (and their spouses or partners). Targeting high-risk groups through this mobile testing program will increase availability of CT and minimize stigma and discrimination that may be encountered at health facilities. PSI will promote their mobile CT through radio announcements and IEC materials approved by the CNLS' BCC Steering Committee and disseminated through subgrantees. All subgrant activities will focus on CT promotion and prevention education around gender issues with a goal of addressing male norms and behavior; increasing women's use of CT services; and reducing violence, sexual coercion, and stigma. In prisons, police stations and CSW organizations, staff and members will be trained as CT Site Coordinators, responsible for CT promotion, preparing lists of individuals willing to test, organizing the logistics for the Mobile CT Unit, and following up on referrals to link those testing HIV-positive to treatment and care services. This program will conduct mobile CT 15 days out of the month with two mobile testing units in order to test a total of 4,620 individuals.

This program will improve the competence of Rwandan staff, organizations and authorities to conduct mobile CT which supports the Rwanda EP five-year strategy of building local capacity. PSI will continue working closely with TRAC, CNLS, GOR Ministry of Internal Security, the National Police, MOH and other CT implementing partners to increase technical expertise in the area of mobile CT; to develop national guidelines for mobile CT that include protection of confidentiality and to develop a supplementary training curriculum for mobile CT counselors. Mobile CT counselors will receive training to encourage individuals to disclose their HIV status and to build interpersonal skills to enhance non-judgmental communication, particularly for highly stigmatized groups. PSI will support TRAC in the development of a database specific to mobile CT that will allow for quarterly data analysis. PSI will provide subgrants to SWAA, the Police Directorate for Medical Services and CSW organizations which will organize CT promotion and post-test clubs and disseminate HIV prevention materials. In close collaboration with TRAC and other ministerial partners, PSI will identify other local associations that can be trained to provide community-based CT promotion and outreach activities, including prevention.

PSI will ensure compliance with national protocols and international quality standards. It will use the national curriculum for testing in prisons and the referral system developed in FY2005 in conjunction with the GOR. To monitor the quality of services, PSI will conduct mystery client surveys, in-service supervision and evaluations of CT counselors. PSI's Technical CT Services Unit will work closely with TRAC and other clinical and non-clinical service delivery sites (including FOSAs, hospitals, integrated VCT centers, CBOs supporting PLWA, and PLWHA associations) to develop a strong and efficient referral system for HIV+ clients at each mobile CT site. For individuals testing positive, this program will immediately put them in touch by phone with the nearest health facility in order to arrange an appointment for a CD4 count. This program will also provide vouchers to cover the cost of transportation for HIV-positive individuals to reach a health facility (maximum 800 Frw per person). Individuals testing positive will be referred to post-test clubs and other community services that provide preventive, positive-living care and support for HIV-infected persons. All others will receive counseling to further prevent HIV transmission. PSI will follow up with the referral health centers and CBOs to monitor the effectiveness of the referral system and to ensure that the clients testing positive are accessing the full package of services available to HIV-positive individuals. This activity delivers high-quality CT services to high-risk populations while supporting the network model, policy development and capacity building as part of the Rwanda EP five-year strategy.