This is a continuing activity from FY 2007. No narrative required.

This is a continuing activity from FY 2007.

Under the RDF, there are a total of three military hospitals and five brigade clinics throughout the country.

Drew University began working in two military hospitals and three brigade clinics in FY 2005 with EP

support. This support included TA and training on ARV and palliative care, M&E, and lab infrastructure.

Drew University is considered a full EP clinical partner working in ARV, TB/HIV, PMTCT, Palliative Care and

PFP. They collaborate with CHAMP for services in military communities such as OVC, and receive drug

procurement from SCMS. In line with national policies, the hospitals use PBF as incentives for facilities.

Drew University improves the capacity of the RDF to provide quality HIV treatment and care for military

personnel, partners and families of military personnel, and community members who live in the surrounding

areas. Services include clinical staging and baseline CD4 count for all patients; control CD4 count every six

months; prevention of opportunistic infections through prophylaxis with cotrimaxazole to eligible patients

based on national guidelines and their diagnosis and treatment; psychosocial support (including counseling

and referrals for positive women victims of domestic violence) and referrals of PLHIV in care to community-

based palliative care services based on their individual need.

In FY 2007, Drew University provided the same palliative care services to 2,000 new PLHIV enrolled at

three military hospitals and three brigade clinics. Through RPM+, Drew University provided diagnostic kits

and drugs to three military hospitals and three brigade clinics to diagnose and treat opportunistic infections

among new PLHIV in care in all eight sites. Drew University also provided technical assistance to RDF to

strengthen linkages between community-based and clinic-based HIV care services. At brigade and/or

community levels, Drew supported the formation of civil-military allied associations of PLHIV and trained

members in provision of home-based care services, access to locally available and/or self-initiated

nutritional support, and HIV Prevention for Positives. Caregivers were trained on adequate management,

distribution and use of care services, and HIV clinical case detection and referral.

In addition, peer educators were trained to provide social support to members. Periodic inter-

brigade/community interactive and experience-sharing discussion group workshops were organized to

increase treatment adherence and encourage sharing of success stories witnessed during the course of

HIV care therapy. At the clinic level, Drew University trained providers in and increased access to

STI/OIs/mental health disorders diagnosis and treatment and integrated these services into brigade level

clinics at three new RDF sites. Forty individuals were trained to provide HIV-related palliative care. In

collaboration with CHAMP, Global Fund, and PMI, Drew University referred 2,000 PLHIV and their families

for malaria prevention services including bed net provision. For clinically stable healthier PLHIV, Drew

University assisted the RDF to strengthen referral to community-based support groups for improved

treatment adherence and increased access to non-clinical HIV care services. Through SCMS, Drew

University provided OI-related drugs, CD4 testing, and OI diagnostics for the clinical management of PLHIV

enrolled in care. Drew University worked with RPM+ to ensure appropriate stock management, inventory

control, and storage for all EP procured commodities at Drew University supported sites.

In FY 2008, these activities will continue. More significantly, Drew University will develop and distribute HIV

care package to all HIV infected individuals receiving care in RDF sites and also pay for mutuelles (health

insurance) for all individuals receiving HIV care in RDF sites. Palliative care services willl be provided to

3,894 PLHIV at eight sites. Through EP support, Drew University will ensure the provision of improved

quality of HIV treatment and care services, train RDF providers at the facility level in diagnosis and

treatment of STI/OIs/mental health disorders diagnosis by integrating these services into the five brigade

clinics. To improve the health of HIV positive patients, Drew University will implement a MTCU linked to the

health facility, which will conduct outreach HIV staging, clinical evaluation and treatment initiation and follow

-up of hard-to-reach HIV infected patients. The MTCU will ensure the provision of a continuum of care and

treatment services which includes, but is not limited to: basic HIV laboratory tests, STIs/OIs screening and

treatment, provision of CTX prophylaxis, ART, ART adherence support, psychosocial support, family

planning, nutrition counseling, PFP, HIV status disclosure, spiritual care, bereavement care as well as

hygiene and malaria education. Palliative care activities will be implemented in conjunction with other

services such as AB, C/OP, TC, FP, ART, TB/HIV, OIs, and/or STIs delivery settings in RDF.

Under the Rwanda Defense Force (RDF), there are a total of three military hospitals and five brigade clinics

throughout the country. Drew University began working in two military hospitals and three brigade clinics in

FY 2005 with EP support. The support modalities include TA and training on ART and palliative care, M&E,

and lab infrastructure. Drew is considered a full EP clinical partner working in ART, TB/HIV, PMTCT,

Palliative Care and PEP. It collaborates with CHAMP for services in military communities such as palliative

care to PLWA and their families, OVC, and receives drugs and reagents procurement from PFSCM. In line

with national policies, the hospitals start performance-based financing as incentives for healtcare providers.

In FY 2007 Drew University began implementing the national TB/HIV policy and guidelines at their three

supported sites. In FY2007, this EP implementing partner supported sites with staff materials and training

routine recording and reporting for the national TB/HIV programmatic indicators. Initial uptake and quality of

services has been variable at different sites. However, the program's achievements include an improvement

in the percentage of TB patients tested for HIV from less than 50% to 75% and improving HIV-infected TB

patient's access to HIV care and treatment (increased proportion of patients accessing cotrimoxazole and

ART). In FY 2008, the goal is to ensure at least 95% of all TB patients are HIV tested, 100% of co-infected

patients receive cotrimoxazole and 100% of those who are eligible receive ART. In addition, at three

supported HIV care and treatment sites, 70-80% of 3894 patients enrolled in HIV care are routinely

screened for TB. However, lower than expected numbers of PLHIV in care and treatment are diagnosed

and treated for TB. The priority in FY 2008 will be to expand implementation of regular TB screening and

for all PLHIV, and for those with suspect TB, ensuring adequate diagnosis and complete treatment with

DOTS.

In FY 2008, this EP partner will support individual sites to both collect quality data, and to report and review

these data in order to understand and improve their program and support integration of TB and HIV services

at the patient and facility level, per national guidelines. Additionally, in FY 2007, two staff from each district

underwent initial respiratory infection control training and have begun drafting infection control plans.

HIV services are not yet available at all facilities in Rwanda. In order to ensure effective integration of TB

and HIV, this EP implementing partner is supporting integrated planning and TB/HIV training to both HIV

services providers and TB services providers. The partner also plans to increase support to integrate

diagnostic services, including coordinating specimen transport for both programs and patient transport for

appropriate diagnostic services (such as chest radiography and diagnostics required for extrapulmonary TB)

to referral centers and appropriate follow-up.

In FY 2008, the partner will continue to support six existing sites and add two new sites for the

implementation of the TB/HIV component of the clinical package of HIV care. These activities support

Rwandan national plan for TB/HIV and EP to prevent, diagnose and treat patients with both TB and HIV

patients.

This activity is continuing from 2007. No new narrative is required.

This is a continuing activity from FY 2007. No narrative required.