New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 14 - HVCT Prevention: Counseling and Testing

Total Planned Funding for Program Budget Code: $5,299,878

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

In FY 2009, PEPFAR clinical, and non-clinical, partners will continue to employ counseling techniques that ensure confidentiality,

minimize stigma and discrimination, and reach those individuals most likely to be infected. Currently, TC is conducted by trained

clinical providers. However, with the expansion of finger-prick TC, PEPFAR funding will support the training of lay counselors as

well. USG technical assistance in the area of prevention with positives (funded in the HVOP program area) will help to ensure

that high quality prevention counseling is being routinely provided to all HIV-infected clients by all PEPFAR-supported partners.

It is estimated that 2% of heterosexual couples in the Rwandan general population are serodiscordant (DHS 2005). However,

modeling of DHS data indicates that over 90% of new heterosexually-acquired HIV infections occurred within cohabiting couples

(Dunkle et al, Lancet 2008). In FY 2009, PEPFAR will use several strategies to expand couples TC. First, clinical partners will

recruit male partners for testing through PMTCT. There is a current GOR policy that supports male involvement in all ANC visits.

During these visits, both PMTCT services for the women, and TC services for the male partners will be offered. Second, PEPFAR

will continue to support a specific and highly weighted performance-based financing indicator on couples testing to provide

financial incentives for such testing. To evaluate and ultimately ensure dissemination of best practices, PEPFAR will fund a public

health evaluation to compare couples testing strategies. Finally, PEPFAR will support technical assistance to the TRACPlus -

Center for Infectious Disease Control/MOH (CIDC) to develop specific guidelines for couples TC.

In order to reach high prevalence populations who are unlikely to access TC services at clinical sites, PEPFAR efforts will

continue to target several groups that are considered to be at higher risk of HIV infection with mobile TC. Four complementary

activities with different points of emphasis are planned: 1) Population Services International (PSI) mobile teams will focus on

military members, their spouses and their families as well as outreach to high risk youth; 2) through the wraparound Transport

Corridor Initiative, Family Health International (FHI) will ensure TC services at 7 SafeTStops for long distance truck drivers, sex

workers and other mobile groups; and 3) PSI, through the Healthy Schools Initiative (HIS), will provide comprehensive TC and

prevention services at four youth centers reaching 25,000 high-risk youth in urban areas. These activities will be coordinated to

avoid duplication and maximize coverage to most at-risk populations. Counseling and testing provided in mobile settings will

follow national guidelines and ensure linkages and referrals to care. Mobile counseling and testing programs will reach 60,000

individuals. PEPFAR community partners Community HIV/AIDS Mobilization Program (CHAMP), PSI, and FHI's Regional

Outreach Addressing AIDS through Development Strategies (ROADS) will continue to support the promotion of TC among OVC

and partners and families of PLWHA, out of school youth, and truckers, respectively. This targeted promotion of TC services will

identify those most likely to be infected and ensure they are referred to sites where they can receive testing, counseling, and

referral to appropriate care. These activities will contribute to increasing the number of people served by both community and

clinical partners.

In FY 2009, PEPFAR will continue its technical and financial support to the CIDC for the development of policies, guidelines, and

tools for TC. This support is designed to elevate and sustain the capacity of the MOH. There is also an emerging need for

guidelines and tools for testing and disclosure of results for children, couples counseling, and abbreviated counseling for PITC.

CIDC will continue to conduct training of trainers and trainings for district supervisors. Quality Control (QC) for HIV testing is

performed on 10% of all testing samples throughout the country and is managed and supervised centrally by the National

Reference Lab (NRL). PEPFAR provides technical and financial support to the NRL in these activities, which are further detailed

in the HLAB program area. In FY 2009, SCMS will continue to procure test kits and laboratory supplies for all PEPFAR-supported

TC activities, as the umbrella commodities management system. This procurement will also include the procurement of lancets to

implement the newly-adopted finger prick specimen collection method.

Table 3.3.14: