As part of the FY07 plus-up, additional funds to the CRS Track 1 mechanism will enable CRS to improve the quality of services currently being provided by program. With current funding, CRS is supporting 3,260 OVC with a variety of services including school fees, school materials, health insurance, gardening and nutrition training, psychosocial support, and limited income generating activities. CRS is currently able to support only 55 OVC with support for secondary education and just 100 OVC with vocational training, given the high costs for these services in Rwanda. This additional funding will allow CRS to provide more OVC with access to secondary school education, vocational training and post-training starter-up kits. CRS will also prioritize supporting other OVC in the same family for a more "family centered" approach, providing insecticide-treated mosquito bed nets for the prevention of malaria, and increase access to the existing goat distribution program (GDP).

Table 3.3.09: Program Planning Overview Program Area: Counseling and Testing Budget Code: HVCT Program Area Code: 09 Total Planned Funding for Program Area: $ 4,195,937.00

Program Area Context:

As Rwanda is successfully advancing toward its goal of providing ART for all persons who need it, the efficient deployment of CT resources becomes ever more important to achieve both identification of HIV-positive individuals and to refine effective testing-based HIV prevention programs. CT activities in FY 2007 will support existing CT sites while expanding services to reach most at risk populations. By the end of FY 2006, the EP will have provided counseling and testing services to over 150,000 individuals in 24 districts in Rwanda. In FY 2007, the EP will add 15 CT facilities for a total of 176 EP-supported sites, train 1,051 counselors, establish 2 new CT mobile units, and provide CT to 175,190 persons. This accounts for nearly 50% of Rwanda's national CT target for 2007.

To strengthen facility-based CT in Rwanda, all USG clinical partners will receive CT funding in 2007. CT will continue to be offered in sites where patients can also receive basic care such as PMTCT, CD4 staging, OI prophylaxis and treatment, nutrition counseling and referral to community services and higher level clinical care. In order to improve the efficiency of rapid CT services, GOR has adopted a change in the specimen collection protocol from venous blood draw to finger-stick collection. In order to reach more clients, EP partners have adopted advanced testing strategies such as increased testing of male partners of PMTCT clients through community sensitization, facilitated couples testing through weekend CT services, improved pediatric case-finding through testing during immunization days and special family/child testing days during vacation days. In FY 2007, EP clinical partners will provide CT through a strategic mix of targeted PIT, family-centered CT, and client-initiated CT services that ensure confidentiality, minimize stigma and discrimination, and reach those individuals most likely to be infected. Through these activities, refugee and military populations will also be reached at three UNHCR-supported camps and six Drew-supported hospitals and brigade clinics, respectively.

In FY 2007, CHAMP community activities will support the promotion of CT among OVC and PLWHA and their families served by CHAMP-supported partners. This targeted promotion of CT services will identify those most likely to be infected and ensure they are referred to appropriate sites to receive care and treatment. These activities will contribute to increasing the number of people served by clinical partners.

In order to reach high prevalence populations, EP partners efforts will continue to focus on several groups considered to be most at-risk. CSWs and their clients, refugees, prisoners, and itinerant workers (tea and coffee plantation workers, fishermen, and truck drivers) are all planned recipients of MVCT. Four complementary activities with different points of emphasis are planned for MVCT. A mobile team fielded by CDC will focus on the generation of actionable, strategic information about most-at-risk-persons (MARPs), while two mobile teams fielded by a TBD partner will emphasize MVCT service delivery through testing for 10,000 MARPs. Through the Transport Corridor Initiative, FHI provides a third use of MVCT by ensuring CT services at 3 SafeTStops for drivers, commercial sex workers, and other mobile groups. Finally, PSI will continue to provide MVCT services to the military as well as military spouses and families. These four implementing partners will coordinate activities to avoid duplication and maximize MVCT coverage to at-risk populations.

Family and couples CT has been endorsed by the GOR and promoted by USG since 2004; however, implementation of these activities has been slow. In FY 2007, EP will help Rwanda to build upon its network of facilities already offering CT by hiring and supporting 200 new "contact counselors" whose primary responsibilities will be to counsel newly-identified HIV-positive individuals, conduct contact tracing to families and sexual partners, and offer HIV testing to these contacts. These counselors will be supported by USG clinical partners and CDC will work with TRAC to establish policies and procedures for family and couples testing, and will play a focal role in the coordination of related M&E. Contact counselors will emphasize offering counseling and testing to the families (sexual partners and children) of PMTCT clients found to be HIV-positive. Contact counselors will also identify discordant couples who will receive intensive prevention counseling. As Rwanda moves towards a disease registry-based system, individuals

identified through family and couples CT will be entered into a database that utilizes the national identification number as the basis of a case report. Moreover, this system will permit the compilation of a sub-registry of HIV-discordant couples to allow expanded activities in prevention for seropositives (see SI overview).

The GOR has now endorsed PIT as a pillar of CT strategy for the foreseeable future and is in the process of establishing guidance for its implementation. Remaining obstacles include defining details of implementation such as opt-in versus opt-out consent requirements, and the appropriate content and duration of pretest counseling in the context of care. In FY 2007, the USG will continue to support TRAC for the development of policies that promote PIT as routine procedure.

Rapid testing for all CT is conducted in accordance with GOR national algorithms which have been developed with USG technical support. In FY 2007, supply chain management for test kits will be further strengthened with the implementation of SCMS as the umbrella commodities management system. PFSCM will provide test kits for all USG-supported CT activities in FY 2007.

Program Area Target: Number of service outlets providing counseling and testing according to 176 national and international standards Number of individuals who received counseling and testing for HIV and 175,190 received their test results (including TB) Number of individuals trained in counseling and testing according to national 1,051 and international standards

Table 3.3.09: