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

This is a continuing activity from FY 2007.

In FY 2007, the EP supported TRAC for central activities to ensure quality of HIV palliative care. TRAC

created a forum for information exchange between facility-based palliative care service providers to identify

weaknesses and constraints as well as methods for program improvement (including quarterly workshops

for health center staff, district supervisors, TRAC and DSS). TRAC defines the roles of different types of

health facilities in OI and STI service delivery in accordance with the network model (i.e. health center

versus hospital) and monitors OI and STI service delivery sites to determine the sustainability of activities.

In addition, in order to integrate palliative care at both facility and community levels to ensure a continuum

of care, the EP supported national policy and guidelines adaptation on palliative care. TRAC is also revising

and integrating into the national HIV training curriculum modules on psychosocial support, nutritional

assessment, counseling and management of malnutrition and screening diagnosis and management of STI.

By the end of FY 2007, TRAC will have designed palliative care-related tools (including PLHIV case

management tools, patient assessment and follow-up forms, and referrals) and counter-referral forms from

facility to community and vice versa. In addition TRAC will have finalized the list of OI drugs, including use

of opioids at clinic and community level for pain management. In FY 2008 TRAC will conduct training of

trainers' sessions on palliative care for 200 doctors; and 100 nurses, social workers, HIV case managers,

and nutritionists. In addition, the EP will continue to support TRAC through a national nutrition advisor

position to oversee all nutrition programming activities at the national level; and providing supervision of

training and nutrition activities implementation at site and community levels.

The EP will also support TRAC for a new staff specialist on STI. This staff will work with STI specialists at

CDC and clinical partners to coordinate training, data analysis and use to better understand the

epidemiology of STI in Rwanda in order to inform HIV prevention partners on special groups at higher risks.

The TRAC specialist on STIs will ensure that site staff are well trained and the tools are available to screen

diagnose treat clients with STIs and their partners and that sociodemographic data are available on those

clients to indicate appropriate prevention strategies.

TRAC will supervise decentralized training on palliative care both for facility-based providers and community

-based providers. TRAC will also design, in collaboration with PBF and the MOH Community Health Unit,

key HIV program-related indicators to monitor for PBF at community level. Lastly, TRAC in collaboration

with SCMS will provide timely and accurate data on OI and STI drug and diagnostics consumption, and OI

and STI-related morbidity and mortality to the CPDS for drugs and reagent quantification. These activities

support the EP five-year strategic goals of promotion of a continuum of HIV care and Rwandan national

plan for palliative care and integration prevention and HIV care interventions.

The overall goal of this activity is to build capacity at central level for TB/HIV guidelines, tools, supervision,

and monitoring and evaluation.

In FY2006, TRAC supported staff positions at central level to support national TB/HIV program. In FY 2007,

TRAC is supporting TB/HIV collaborative activities at the central level through continuation of an existing

and two additional TB/HIV advisors at the national TB program to oversee collaborative activities, which

support guidelines, curriculum, and tool revision, networking with PNILT, AIDSRelief, and supervision of all

EP and non -EP sites for quality TB and HIV services to co-infected patients.

In FY2008, EP funding will continue to support the positions of the national advisors at TRAC. The advisors

lead national activities on TB/HIV as related to guidelines, norms and tools review. They are part of the

national team of TB/HIV supervisors in addition to those located at AIDSRelief, FHI, CDC, PNILT, and

WHO. They will plan and coordinate TB/HIV training at the central and decentralized level. The team

participates in monthly joint supervision of TB/HIV activities at the district level and reports issues and gives

feedback to the national technical working group. The TB/HIV advisors at TRAC support the drafting and

implementation of a TB infection control plan at selected hospitals. They participate in the national

supervision team for quality of health services including TB. Finally, with EP support, TRAC will train 200

trainers in TB/HIV integration. These activities support the national TB/HIV collaborative and the EP under

its component of integration for TB/.HIV

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

Noted April 24, 2008: With these funds TRAC in collaboration with all clinical partners will conduct a PHE to

test interventions that will decrease early mortality of patients on ART aminly screening and preventive

therapy for cryptococcus meningitis, TB screening and intensive follow-up of patients at risk (low CD-4,

bedridden, malnourished, etc.).

Quality assurance, improvement and control are a vital part of HIV services - particularly as more people will

initiate ART. Moreover, greater integration of overall services (for example Nutrition with ART services) is

needed to ensure successful mainstreaming and assure a quality continuum of care.

In FY 2006, TRAC with TA from EP clinical implementing partners developed national clinical norms,

guidelines and tools for ART, including registers, patient forms, and clinical IEC materials for patients.

TRAC undertook regular supervision to ensure that HIV services at site level comply with these national

norms. In FY 2007, EP is expanding support to TRAC for routine monitoring of key ART impact indicators

to ensure program quality. EP clinical services staff will continue providing TA to TRAC to revise guidelines,

reach an additional 200 trainers and expand new activities in joint supervision to improve program quality.

In FY 2008, the EP will support clinical partners, TRAC and MOH decentralization office for QA/QI/QC of

national HIV programs. However, because the priority of the national program has been on the rapid scale

up of HIV services, recent field supervision has shown variability in service quality and interpretations of the

basic package of services. Furthermore, reporting and field record keeping lacks consistency and national

strategic vision. With these new funds, the EP will work with MOH to reinforce ART program quality through

substantial strengthening of the TRAC quality assurance and facilitative supervision function.

This activity has two basic components:

One component is to reinforce the M&E unit at TRAC for ART program monitoring, joint supervision and

data analysis and use to improve program quality. The second component will be to use the expertise of an

international institution to support TRAC in revising the definition of the ART basic standards of care that

guarantee improved service quality at individual sites, to conduct training and supervision of DHTs in those

standards and their applications at lower levels of the health system. The standards will focus in three areas

namely the provision of services, the link with communities and administrative services. It is anticipated that

this activity will be co-funded by both GFATM and EP.

This activity supports the EP five-year strategy for national scale-up and sustainability and the Rwandan

Government ART decentralization plan.

The EP has made significant investments in surveillance in Rwanda since 2004. TRAC's capacity to carry

out surveillance activities has markedly improved over the years. In FY 2008, TRAC will undertake multiple

surveillance activities aimed at better understanding the state of the HIV epidemic in Rwanda. TRAC, in

collaboration with CDC, will continue sentinel surveillance at 30 antenatal care facilities, train 60 site

personnel, and procure tests and other materials. Support will also be provided for the preparation and

implementation of the 2008 BSS+, which will focus on high risk groups. Data analysis and results

dissemination will take place in 2009. A new activity to be implemented in FY 2008 is ARV resistance

surveillance. This will be carried out in collaboration with CDC, WHO and the NRL and will focus on two

sites in its initial phase.

Building on activities implemented in previous years, TRAC ICT unit staff will continue to provide on-site IT

training to all ART sites, including the use of TRACnet (Rwanda's phone-and web-based reporting system

for HIV/AIDS) for reporting of ARV drug and program indicators. Given the plan to extend TRACnet beyond

HIV/AIDS, the EP will support an increased number of staff in the TRAC ICT unit to support the roll-out of

new TRACnet functionalities and modules, as well as provide assistance to users through a "help desk."

These staff will also train facility based personnel in basic IT software packages (word processing and

spreadsheet software).

In addition, TRAC will continue its collaboration with CDC and the NRL in the area of HIV incidence

surveillance, continuing the BED or other appropriate incidence assay using specimens from FY 2006 and

FY 2007 sentinel surveillance. TRAC will also conduct a third threshold survey of ARV drug resistance

including analysis and dissemination of results.

In the area of M&E, TRAC will continue to support data analysis and use on clinical care, treatment, and

PMTCT services to monitor quality of services. The TRAC M&E unit, with support from the TBD M&E

contractor, will conduct data reliability exercises on PMTCT, TC, and ART data. The unit will receive EP

assistance to recruit additional staff. Support will also be provided to build DQA capacity at the district level,

in collaboration with the MOH. The TRAC M&E unit will continue to maintain the postings and organization

of the digital library. The focus of M&E activities in FY 2008 under the TRAC cooperative agreement will be

on enhanced data quality, planning, reporting, and utilization of data for program improvement.

This activity reflects the ideas presented in the EP Five-Year HIV/AIDS Strategy in Rwanda and the GOR

National Multi-sectoral Strategic Plan for HIV/AIDS Control by directly supporting the development of a

sustainable strategic information system for the national HIV/AIDS program.