Noted April 24, 2008: The monies in the UNHCR mechanism are being split at the request of State/BPRM.

Some UNHCR monies will go into a direct contract with ARC, which will continue to support the Gihembe

and Nyabiheke camps for HIV services. The remaining monies will be given to UNHCR to ensure HIV

services at the Kiziba camp. The funding split was based on COP 08 targets and the proporotion of the

budget that each mechanism will receive. There are no changes to the narrative as there are a standard set

of activities within PMTCT, HVAB, H/OP, HBHC, HVTB, HVCT, and HTXS that shoudl be undertaken by

both UNHCR and by ARC at all three refugee camps.

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

Noted April 24, 2008: The monies in the UNHCR mechanism are being split at the request of State/BPRM.

Some UNHCR monies will go into a direct contract with ARC, which will continue to support the Gihembe

and Nyabiheke camps for HIV services. The remaining monies will be given to UNHCR to ensure HIV

services at the Kiziba camp. The funding split was based on COP 08 targets and the proporotion of the

budget that each mechanism will receive. There are no changes to the narrative as there are a standard set

of activities within PMTCT, HVAB, H/OP, HBHC, HVTB, HVCT, and HTXS that shoudl be undertaken by

both UNHCR and by ARC at all three refugee camps.

Rwanda is host to nearly 50,000 refugees in four camps around the country. Refugee populations are

considered to be at higher risk for diseases, particularly HIV, as well as violence, economic, and

psychological distress. While much is currently unknown about HIV prevalence rates in the camp

populations in Rwanda, recent service statistics show a prevalence of 5% among TC clients.

Since 2005, the EP has provided refugees with HIV/AIDS prevention and care services with linkages and

referrals to local health facilities for treatment. In FY 2008, all clinical partners, including UNHCR, are

funded for PFP activities under the HBHC program area. However, UNHCR implements prevention

activities in the refugee community as well as in the clinical setting, and will therefore receive funding to

continue these activities. UNHCR will promote AB messages to the refugee community, including in- and

out-of-school refugee youth, men, and vulnerable women of reproductive age.

UNHCR will train or, as necessary, provide refresher training to peer educators using AB materials adapted

for the refugee context. UNHCR will support interpersonal prevention activities that aim to increase youth

access to prevention services, such as anti-AIDS clubs, life-skills training, school-based HIV prevention

education, and community discussions. Messages delivered will focus on abstinence and fidelity and also

include topics on the relationship between alcohol use, violence, HIV, and stigma reduction. Young girls in

the refugee community, particularly female OVC, are vulnerable to predatory sexual behaviors of older men,

as well as child sexual abuse, domestic violence, and sexual harassment at school. Prevention efforts

under this activity will focus on changing social acceptance of cross-generational and transactional sex.

Key influential community members such as traditional and religious leaders and refugee camp leaders will

also reinforce the messages of abstinence, delayed sexual debut, being faithful, reduction of GBV and

responsible consumption of alcohol. As many risky behaviors can often be linked to other contextual factors

such as unemployment, poverty, trauma, and psychosocial needs, UNHCR will strengthen referrals and

mechanisms in coordination with other partners to provide refugee clients and their family members access

to IGA, OVC programs, food support through Title II and WFP, vocational training, trauma counseling, legal

support, and mental health care and support for at-risk clients.

CSWs are an important target group due to their risk exposure, difficulties in negotiating condom use,

psychosocial needs, and the lack of alternative means for generating income. Cost-shared with HVOP

funds, UNHCR will help establish support groups for CSWs to create opportunities for exchange and peer

support, linkages to IGA and microfinance activities, vocational training, promotion of healthy RH behaviors,

and psychosocial support and counseling.

Noted April 24, 2008: The monies in the UNHCR mechanism are being split at the request of State/BPRM.

Some UNHCR monies will go into a direct contract with ARC, which will continue to support the Gihembe

and Nyabiheke camps for HIV services. The remaining monies will be given to UNHCR to ensure HIV

services at the Kiziba camp. The funding split was based on COP 08 targets and the proporotion of the

budget that each mechanism will receive. There are no changes to the narrative as there are a standard set

of activities within PMTCT, HVAB, H/OP, HBHC, HVTB, HVCT, and HTXS that shoudl be undertaken by

both UNHCR and by ARC at all three refugee camps.

Rwanda is host to nearly 50,000 refugees in four camps around the country. Refugee populations are

considered to be at higher risk for diseases, particularly HIV, as well as violence, economic and

psychological distress. While much is currently unknown about HIV prevalence rates in the camp

populations in Rwanda, recent service statistics show a prevalence of 5% among TC clients.

Since 2005, the EP has provided refugees with HIV/AIDS prevention and care services with linkages and

referrals to local health facilities for treatment. In FY 2008, all clinical partners, including UNHCR, are

funded for Prevention for Positives activities under HBHC. However, UNHCR implements prevention

activities in the refugee community as well as in the clinical setting, and will therefore receive funding to

continue these community-based prevention activities.

The 2004 UNHCR BSS and the FHI-supported RH assessment found high risk behaviors among refugee

camp populations, including multiple partners, transactional sex, male cultural and societal norms that

encourage high-risk behaviors and GBV, very low condom use, and alcohol abuse. UNHCR will target HIV-

positive refugee patients, including discordant and married HIV-positive couples; unmarried HIV-positive

refugee men and women; and ART patients. Health providers and volunteers will also target C/OP

messages to high-risk populations in the camps-at-large. Target populations include TC clients who test

negative, non-married and unemployed men, women- and out-of-school youth at-risk, STI clients, CSWs,

and refugees with demonstrated high-risk behaviors such as alcohol abuse and a history of GBV.

The EP funds will support C/OP activities in three refugee camps. BCC will target high-risk and vulnerable

refugee populations and use anti-AIDS clubs, peer educators, community forums, and relevant IEC

materials. Key messages will promote risk reduction behaviors, condom use, and address social norms,

GBV, and alcohol abuse. To monitor and track the reach of these messages and condom uptake, UNHCR

will integrate program-level indicators, including DELIVER-supported condom distribution and tracking

indicators into existing reporting forms and tools. EP will leverage UNFPA and GFATM public sector

condoms for the camps.

This is a continuing activity from FY 2007.

Rwanda is host to almost 50,000 refugees in camps around the country. Refugee populations are

considered to be at high risk of infectious diseases, in particular HIV, as well as GBV and other forms of

violence, and economic and psychological distress. While much is currently unknown about HIV prevalence

rates in the camp populations in Rwanda, recent service statistics of newly implemented TC and PMTCT

programs in two camps record a prevalence rate around 5% among those tested, with at least 200

individuals currently known to be living with HIV. Since 2005, the EP has supported AHA and ARC to

provide HIV prevention and care services in Kiziba, Gihembe, and Nyabiheke refugee camps with linkages

and referrals for treatment. As of FY 2007, UNHCR is now the prime partner for these activities and

subgrants to implementing partners ARC and AHA. FY 2008 funding for this activity will support the

provision and expansion of palliative care services to 500 PLHIV and the training of 120 health providers,

laboratory technicians, and community volunteers in Kiziba, Gihembe, and Nyabiheke refugee camp health

clinics and communities.

UNHCR partners will ensure the provision of, or referrals for diagnosis and treatment of OIs and other HIV-

related illnesses (including TB), routine clinical staging and systematic CD4 testing, medical records for all

HIV-positive patients and infants, and referrals to community-based psychosocial and palliative care

services. Infants born to HIV-positive mothers will be provided CTX; early infant diagnosis through PCR;

and ongoing clinical monitoring and staging for ART. In collaboration with EP clinical partners, UNHCR

partners will work with the Byumba, Kibuye, and Ngarama DHTs to ensure that health clinic providers

receive training or refresher training in basic management of PLHIV, including training in ART adherence

support, and in the identification and management of pediatric HIV. UNHCR partners will monitor and

evaluate basic care activities through ongoing supervision, QA, and data quality controls. They will continue

to build the capacity of local refugee health care providers to monitor and evaluate HIV/AIDS basic care

activities through ongoing strengthening of routine data collection and data analyses for basic care.

SCMS will procure and distribute through CAMERWA all palliative care and OI drugs, laboratory supplies

and diagnostic kits. UNHCR partners will work with SCMS and the districts to ensure appropriate storage,

management and tracking of commodities, including renovation of pharmacy units at the health centers for

adequate ventilation and security.

UNHCR will provide technical support and monitoring of IP activities and data collection, and ensure

appropriate reporting through the hiring of an HIV/AIDS technical and program manager. This activity

addresses the key legislative areas of gender through reduction of GBV and support for women confronted

with GBV as well as increasing women's access to income generating activities; wrap around through Title II

food activities, and stigma and discrimination through increased community participation in the care and

support of PLHIV.

This activity supports the EP five-year strategy by providing prevention, care, and treatment to vulnerable

and high-risk populations.

Noted April 24, 2008: The monies in the UNHCR mechanism are being split at the request of State/BPRM.

Some UNHCR monies will go into a direct contract with ARC, which will continue to support the Gihembe

and Nyabiheke camps for HIV services. The remaining monies will be given to UNHCR to ensure HIV

services at the Kiziba camp. The funding split was based on COP 08 targets and the proporotion of the

budget that each mechanism will receive. There are no changes to the narrative as there are a standard set

of activities within PMTCT, HVAB, H/OP, HBHC, HVTB, HVCT, and HTXS that shoudl be undertaken by

both UNHCR and by ARC at all three refugee camps.

Rwanda has nearly 50,000 refugees in camps around the country. Refugee populations are considered to

be at high risk of infectious disease, in particular HIV, as well as GBV and other forms of violence, and

economic and psychological distress. While much is currently unknown about HIV prevalence rates in the

camp populations in Rwanda, recent service statistics of newly implemented VCT and PMTCT programs in

two camps record a prevalence rate around 5% among those tested, with at least 200 individuals currently

known to be living with HIV. Since 2005, the EP has supported UNHCR implementing partners AHA and

ARC to provide HIV prevention and care services in Kiziba, Gihembe and Nyabiheke refugee camps with

linkages and referrals for treatment. In FY 2007, the EP consolidated its support by funding UNHCR

directly to expand the package of services for prevention, care, and treatment services for PLHIV. UNHCR

subcontracts to AHA and ARC who will continue to implement activities in the camps.

In FY 2007 this EP implementing partner began implementing the national TB/HIV policy and guidelines at

their three supported sites. The program's achievements include an improvement in the percentage of TB

patients tested for HIV from less than 70% to 100% 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 100% of all TB patients are HIV tested, 100% of those who are eligible receive

cotrimoxazole and 100% of those eligible receive ART.

In addition, at UNHCR-supported HIV care and treatment sites, 100% of 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 2007, UNHCR supported sites with materials and training in routine recording and reporting of

national TB/HIV programmatic indicators. Initial uptake and quality has been variable at sites. In FY 2008,

UNHCR 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 UNHCR is supporting integrated planning and TB/HIV training to both HIV services providers and

TB services providers. This EP partner also plans to increase support for integration of 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 UNHCR will continue to support 3 existing sites for the implementation of the TB/HIV component

of the clinical package of HIV care.

In coordination with the HIV PBF project, partners will shift some of their support from input to output

financing as done by national PBF project focusing on quality indicators. Examples of quality indicators

include correctly filling stock control cards in X-ray departments, the percentage of TB lab exams that are

corroborated during quarterly controls, the number of X-rays of good quality with correct diagnosis and

report in patient file, and the quality of sputum smear microscopy as measured by the percentage of false

negatives and false positives. Payment of indicators is linked to the quality of general health services

through adjustments of payments based on the score obtained using the standardized national Quality

Supervision tool and a performance incentive for the production of more than agreed upon quantities of

each indicator.

This activity reflects the ideas presented in the Rwanda EP five-year strategy and the Rwandan National

Prevention Plan by advancing the integration of TB/HIV services through the operationalization of policies

and increased coordination of prevention, counseling and testing and care and treatment services. Lessons

learned from integrating TB and HIV will serve in integrating HIV into the primary healthcare

Noted April 24, 2008: Some funding allocated to ARC.

This activity is continuning from FY 2007. No new narrative is required.

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