Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 1527
Country/Region: Rwanda
Year: 2009
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $4,416,244

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $126,000

This is a continuing activity from FY 2008. No narrative required.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12903

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12903 8184.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $166,300

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

8184 8184.07 HHS/Centers for US Centers for 4358 1527.07 CDC Country $42,300

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $126,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $20,000

ACTIVITY UNCHANGED FROM FY 2008

In FY 2009, CDC will continue to support two staff members of the PEPFAR prevention team. Working in a

country with a national HIV prevalence rate of 3.1%, it is vital for PEPFAR to design and implement

prevention strategies that can affect behavior change and reduce the number of new infections in order to

stem the progression of the epidemic.

The prevention team will be responsible for evaluating prevention activities, monitoring the epidemic

through analysis of available data, collaborating with the National Prevention TWG on development of best

practices, and providing strategic guidance to the country program.

The Prevention Specialist will also manage the PEPFAR prevention and TC activities by providing general

oversight, TA, and support for monitoring and reporting of supported activities. This will include

management of and TA to the prevention follow-on activities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12904

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12904 2849.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $390,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

7265 2849.07 HHS/Centers for US Centers for 4358 1527.07 CDC Country $0

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

2849 2849.06 HHS/Centers for US Centers for 2598 1527.06 CDC Country $0

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $20,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $60,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY 2008, efforts were begun to more precisely understand the drivers of the epidemic in Rwanda by

estimating the size of the population of CSWs in Kigali. These activities will be continued and expanded in

FY 2009. CDC will support technical activities for estimation of MARPS population including commercial

sex workers, street youth, and drug users.

CDC will provide TA to work with partners and GOR in estimating the magnitude of these populations.

These funds will also continue to support CDC staff in attending trainings in MARP estimation.

In FY 2008, FHI will work closely with the OGAC prevention technical working group to define, implement,

and evaluate programming for prevention of HIV in Persons Engaged in High-Risk Behaviors (PEHRB).

Specifically, multiple technical assistance visits will result in collaboration with FHI to define and implement

a package of services for sex workers, including community-based outreach, TC, condom programming,

STI screening and treatment, and referral to PMTCT and HIV treatment and care for those who are HIV-

infected. In addition, the TWG and FHI will work together to determine policy, training, procurement and

data needs to facilitate comprehensive HIV prevention programs for national coverage in Rwanda, and

prepare tools which can assist all partners in implementing and expanding such programs.

Technical support from the TWG will also help to conduct population size estimations of two to three high

risk groups including sex workers and men who have sex with men. Strategic information obtained by these

estimations is necessary in order to determine prevalence and will contribute to the overall understanding of

these groups in Rwanda and their need for HIV services.

The second component of this activity is to provide technical assistance to assure that activities provided for

in FYs 2007 and 2008 requiring clinical and community partners to carry out Prevention for Positives are in

fact carried out and conducted using the best methods available. The activity will provide for TA from US-

based scientists to clinical and community partner organizations and their facilities. Funding for this activity

includes travel for technical support.

Prevention for Positives is an essential part of a total prevention and care package to reduce the

transmission of HIV disease.

Reinforcing existing programs by assuring training of physicians and community counselors who will be

providing prevention counseling for HIV positives will help reinforce partner reduction and safer sex

practices in this high risk group. In addition, assuring strategic placement of trained counselors and training

physicians who are assigned and/or working at ART sites will help ensure that clients most in need will

benefit from the counseling. Community counselors will promote couples counseling and provide

prevention for positive messages to all their clients, but particularly PLHIV, to reduce their high risk

behaviors through abstinence, being faithful to one partner or promoting "secondary abstinence" and

counseling and discussing condom use for those discordant couples. Trained community counselors will

benefit from training HIV positive individuals on aspects of health, including prevention to all their HIV

positive clients.

In this activity, trainers will use a provider counseling manual currently being finalized at CDC and a

DOD/OGAC manual based on the U.S. military program in practice since 1985. The program is based on

one-hour modules for counselors to train/discuss with HIV positive patients issues including abstinence,

safer sex, nutrition, drugs and alcohol, partner notification, disclosure, and medical aspects of HIV.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16878

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16878 16878.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $140,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

* Increasing women's legal rights

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $60,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY 2009, the program will need support activities to provide technical assistance to assure that activities

provided for in FY 2008, requiring partners to carry out Prevention with Positives, are in fact carried out and

conducted using the best methods available. The activity will provide for TA from US-based scientists to

clinical and community partner organizations and their facilities. Funding for this activity includes travel for

technical support.

The US-based scientists will train trainers in the MOH and in partner organizations to assure that Prevention

with Positives is extensively and appropriately employed. Particular emphasis will be placed on PLHIV, to

reduce their high risk behaviors through abstinence and being faithful to one partner or promoting

"secondary abstinence". These scientists will also train trainers for community counselors to assure

promotion of couples counseling discussing condom use for those discordant couples. This TA will also

focus on developing an M& E system for Prevention with Positives activities.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Biomedical Prevention: Blood Safety (HMBL): $35,000

THIS IS A NEW ACTIVITY FOR FY 2009.

CDC provides direct support for Blood Safety activities through CDC technical staff in-country as well as

through short-term TA from CDC headquarters. In FY 2009, CDC GAP HIV Prevention Branch will provide

TA to support the National Center for Blood Transfusion (NCBT) in best practices of blood safety. The TA

will also provide consultation on applying PEPFAR's new technical considerations in blood safety for

Rwanda.

The CDC will support the NCBT by providing TA for the management and operation of the transfusion

service. CDC technical support to the NCBT is consistent with the five-year strategic plan to strengthen

blood collection and distribution, to standardize technical standards and to implement QA of HIV-related

services.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.04:

Funding for Biomedical Prevention: Injection Safety (HMIN): $35,000

ACTIVITY IS NEW IN FY 2009.

PEPFAR provides direct support for Injection Safety activities through CDC technical staff in-country as well

as through short-term TA from CDC headquarters. In FY 2009, CDC GAP HIV Prevention Branch will

provide TA to support the Government of Rwanda (GOR) in applying and implementing best practices for

injection safety. The Prevention Branch will also provide guidance for the transition of injection safety

support from a central mechanism to a country mechanism. Additionally, the TA will consult and advise the

Rwanda program on new PEPFAR technical considerations for injection safety. The CDC will also support

the MOH's Departments of Environment and Hygiene by providing TA for the management and operation of

Injection Safety services.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.05:

Funding for Care: Adult Care and Support (HBHC): $75,217

ACTIVITY IS NEW IN FY 2009

The aim of this funding is to support technical assistance, training, and basic program evaluation activities

to improve basic care and support services, both clinical and non-clinical, for PEPFAR implementing

partners in Rwanda. CDC Direct funding has not been previously applied in this critical and broad area.

CIDC has recently completed draft guidelines for opportunistic and sexually transmitted infections, as well

as revised guidelines for cotrimoxazole prophylaxis, and TA will help to support on-going implementation of

these guidelines and evaluation of scale-up activities. This will include TA to support expansion elaboration

of national cervical cancer screening guidelines and implementation and scale-up plans. Additional

activities will include TA to evaluate the success of linkage between and referrals from HIV care and

treatment services and long-lasting insecticide-treated bed-nets, and patient outcomes in pre-ART services.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $387,000

THIS IS A CONTINUING ACTIVITY FROM FY 2008, ALREADY APPROVED

New/Continuing Activity: Continuing Activity

Continuing Activity: 12908

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12908 2846.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $650,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

7262 2846.07 HHS/Centers for US Centers for 4358 1527.07 CDC Country $220,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

2846 2846.06 HHS/Centers for US Centers for 2598 1527.06 CDC Country $315,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $87,432

ACTIVITY UNCHANGED FROM FY 2008:

CDC direct funding under this program area is aimed at building national capacity to support the expansion

of quality pediatric HIV care and treatment programs in Rwanda.

In FY 2008, the CDC will increase its in-country staff by hiring a pediatric HIV care and treatment advisor.

This advisor will be part of the PMTCT/Pediatric HIV team; increasing the technical capacity of the USG

team in Rwanda as pediatric HIV care and treatment programs continue to grow. Part of the funds

requested will be used to support on-going training needs for the pediatric HIV advisor and other team

members, as well as to fund participation in relevant pediatric HIV conferences and/or purchase of

educational materials for continuing medical education of the staff.

Funding is also being allocated for in-country staff to conduct joint, routine supervisory site and district-level

visits to USG and CDC-funded pediatric HIV programs in Rwanda. These visits will serve to provide

technical guidance, evaluate progress and identify best-practices at USG-supported sites and inform future

scale-up activities in Rwanda.

Part of the requested funding, will be used to obtain headquarters (HQ) and technical working-group (TWG)

assistance to support CIDC develop updated training materials and job-aids for health care providers caring

for HIV-exposed and infected infants, children and adolescents. These materials include: pediatric

treatment training modules that include changes in treatment indications for HIV-infected infants and

changes in CD4 thresholds for treatment initiation in children between 36 to 59 months of age. In addition,

up-dated ARV dosing tables for children will also be developed in collaboration with CIDC and other

pediatric HIV treatment providers in Rwanda. Work to up-date and improve tools and training materials for

the prevention, management and diagnosis of common infectious complications and OIs in children planned

for FY 2008 will most likely need additional TA in FY 2009. At the same time, materials to support training

of health care providers to counsel and test children and their parents and address disclosure issues in the

pediatric population started in FY 2008 will be completed in FY 2009 with TA from CDC headquarters and in

-country USG staff.

Short-term TA from CDC HQ, is also envisioned to assist CIDC and the MoH complete work to integrate

pediatric HIV services into MCH programs in Rwanda. This work will complement that supported by USAID

and BASICS to expand the use of up-dated IMCI modules at health center levels. TA will also be used to

assist the GoR finalize the development of up-dated childhood health cards that include HIV related

information of the mother and the infant to improve linkages between PMTCT and other MCH and health

care programs and finalize scale-up plans to increase access to EID services to all sites offering PMTCT

services.

For FY 2009, CDC will continue to support program evaluation activities related to pediatric care and

treatment activities; these will include evaluation of pediatric HIV program data from TRACnet. Some

relevant areas of analysis will include use of second line drugs, retention into care and treatment rates for

children and quality of care and treatment services for children among others; headquarters TA will be

sought to develop, in collaboration with the MoH, appropriate protocols, data analysis approaches and

protocols to conduct these evaluations. Inclusion of expanded pediatric HIV indicators developed for

PEPFAR activities in the next five years will also require TA support from the SI and PMTCT/Pediatric HIV

TWG in FY 2009.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $87,432

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $130,000

This is a continuing activity from FY 2008. No narrative required.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12908

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12908 2846.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $650,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

7262 2846.07 HHS/Centers for US Centers for 4358 1527.07 CDC Country $220,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

2846 2846.06 HHS/Centers for US Centers for 2598 1527.06 CDC Country $315,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $130,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $176,000

ACTIVITY UNCHANGED FROM FY 2008.

The overarching goals of the proposed activities are: (1) improve the capacity at national level, district and

site level to provide quality prevention, diagnostic and treatment services to HIV-infected patients co-

infected with tuberculosis (TB) and their families; (2) to build capacity within TRACPlus-CIDC of the MOH to

effectively coordinate TB/HIV activities, in collaboration with the National TB program and, (3) to conduct

key evaluation activities to inform the national TB and HIV programs.

Since the initiation of PEPFAR supported activities in Rwanda, the USG has worked with the MOH to

strengthen the capacity of the health care system to provide TB and HIV services in the country. Support

for these activities has been provided at central level to the National TB and HIV programs, at district health

levels and at site levels. In FY 2007, CDC, in collaboration with MOH and USG-funded implementing

partners, implemented an evaluation of TB screening in pediatric HIV patients. CDC supported a wide

variety of technical assistance from CDC Atlanta for training in TB laboratory techniques, TB lab

assessment, and targeted evaluations in TB/HIV. In FY 2007, CDC also supported technical assistance for

a CDC international expert in infection control to support a national training organized by WHO. In order to

meet the PEPFAR priority of providing quality smear microscopy services and effective TB diagnostic

services for PLHIV, CDC supported short-term TB laboratory TA to work with NRL and Columbia

University/ICAP to enhance the performance of the smear microscopy external quality assurance (EQA)

system and the quality of culture and drug sensitivity testing services. Surveillance for extremely drug-

resistant TB (XDR) will be conducted at CHK among TB patients that are failing TB treatment. In FY 2008,

CDC is also funding regional technical assistance to support the TB Unit at TRACPlus-CIDC to implement

an electronic TB register in Rwanda, and to link it to the TRACNet web-based reporting system for

HIV/AIDS. MOH has still not determined whether isoniazid preventive therapy (IPT) will be supported in

Rwanda. TRACPlus-CIDC expects to review the available evidence and, with expert consultation, make a

determination. In the event that MOH decides to support IPT policy development in FY 2008, CDC TA

would likely be sought in FY 2009 for development of implementation and scale-up plans.

In FY 2009, CDC will continue to bring TB experts to train additional central and district staff in infection

control practices based on the soon-to-be-finalized national infection control policy. Two TDYs will be

supported, one for the expanded training and another for infection control implementation and scale-up plan

review. CDC will continue to support TDYs for the targeted evaluations initiated in FY 2007, including the

evaluation of TB screening and diagnosis among HIV infected children, the evaluation of the diagnosis

process for extra pulmonary and smear negative TB, as well as a new evaluation to validate the national

tool used to screen PLHIV for TB. A total of six to eight TDYs will be supported for these evaluations. CDC

will continue to support the laboratory system in Rwanda for new TB diagnosis, scale-up TB culture

capacity, and decentralize quality assurance for microscopy and TB culture, and add capacity for DST for

MDR and X-DR TB. A total of four to six TDYs will be supported for these laboratory related activities.

Lastly, CDC will provide technical assistance to TRACPlus HIV/AIDS and TB Units and PEPFAR

implementing partners currently supporting HIV care and treatment services in ten prisons in Rwanda for

routine TB surveillance and TB-HIV integrated activities.

Of note, in FY 2009, funding previously directed to WHO STOP TB activities will be provided directly to

TRACPlus, as part of on-going efforts to encourage national disease control agencies to assume financial

administrative responsibility and oversight of core TB-HIV integrated activities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12905

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12905 2850.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $170,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

7266 2850.07 HHS/Centers for US Centers for 4358 1527.07 CDC Country $42,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

2850 2850.06 HHS/Centers for US Centers for 2598 1527.06 CDC Country $45,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $120,218

This is a new activity in FY 2009

In FY 2009, CDC will continue support Couples Counseling and Testing (CVCT) activities integration into

the Rwanda National Program. In addition, CDC will be supporting partners to carry out a Counseling and

Testing Public Health Evaluation.

CDC will provide TA to support development of CVCT M&E activities, including supporting the rollout of

CVCT, follow-up of discordant couples, and EP strategic information activities. These funds will also

continue to support CDC staff in attending CVCT related trainings.

In addition, during FY 2009, Rwanda will serve as a regional training center for CVCT. GOR and EP staff

will attend the CVCT trainings. The training activities will contribute to building sustainable implementation

of CVCT, monitor its effectiveness in preventing new infections, and focus on CVCT data quality and data

utilization for CVCT program improvement.

This funding will also support part of salaries of two staff member of the EP prevention team. Working in a

country with a national HIV prevalence rate of 3.1%, it is vital for the EP to design and implement prevention

strategies that can affect behavior change and reduce the number of new infections in order to stem the

progression of the epidemic.

The prevention team will be responsible for evaluating prevention activities, monitoring the epidemic

through analysis of available data, collaborating with the National Prevention TWG on development of best

practices, and providing strategic guidance to the country program.

The Prevention Specialist will also manage the CDC-funded prevention and TC activities by providing

general oversight, TA, and support for monitoring and reporting of supported activities. This will include

management of and TA to the Prevention Follow-on activities.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Laboratory Infrastructure (HLAB): $330,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

1. Elaboration of Activities

CDC provides direct support for laboratory infrastructure activities through CDC technical staff in-country as

well as through short-term TA from CDC headquarters. In FY 2008, CDC GAP International Laboratory

Branch provided TA to support the NRL in viral load testing using dried blood spots and dried plasma spots.

The CDC recruited a direct hire to manage the laboratory portfolio. The new CDC laboratory advisor

provides day-to-day oversight of EP-funded lab partner activities, including the NRL cooperative agreement

and other clinical partners. The lab position also provides ongoing assistance with development and

implementation of national laboratory policy. The lab advisor works with the CDC laboratory coalition

partners and others to develop a plan for TA and laboratory resources during FY 2009 and work with them

to complete the projects which are being funded. Additional TA will be provided by the GAP International

Laboratory Branch to support the implementation of HIV drug resistance testing and accreditation to WHO

standards.

In FY 2009, the CDC will support the NRL by providing TA for the management and operation of the

laboratory. To further sustainable in-country capacity, the NRL will hire a new laboratory operations

manager and two quality assurance managers, one for the NRL and another to focus on the laboratory

network. Additionally, the CDC will provide TA by hiring a senior laboratory officer to work with the NRL to

mentor and lead activities that will allow the NRL to manage its resources better and to plan its programs in

a more efficient manner. The new CDC position will provide a direct link to the NRL to manage the USG

cooperative agreement and provide support for USG programming.

CDC technical support to NRL is consistent with Rwanda's five-year strategic goals of strengthening NRL

capacity to manage a national network of laboratories and to standardize technical standards and to

implement QA of HIV-related services through a network model.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12909

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12909 2847.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $400,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

7263 2847.07 HHS/Centers for US Centers for 4358 1527.07 CDC Country $320,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

2847 2847.06 HHS/Centers for US Centers for 2598 1527.06 CDC Country $80,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.16:

Funding for Strategic Information (HVSI): $503,200

ACTIVITY UNCHANGED FROM FY 2008.

CDC will continue to provide long-term TA through a CDC core technical field team which is comprised of

an Epidemiologist, an inter-agency HMIS Coordinator a Monitoring and Evaluation Specialist and a data

manager. Short-term TA in surveillance, HMIS, and M&E will also continue to be provided during the

planned period.

During FY 2009, CDC will continue to support an HMIS Coordinator to coordinate HMIS activities with the

GOR, PEPFAR agencies, PEPFAR partners, and multilateral organizations such as the WHO and UNAIDS.

The Coordinator will assist the GOR in strategic planning for information systems in the health sector and

will help strengthen GOR capacity in information systems development, implementation, management and

data use to collect critical data. The HMIS Coordinator will also provide technical support to PEPFAR

partners to implement the HIV Registry (in collaboration with Voxiva and TRACPlus-CIDC), and to scale up

the rollout of the electronic TB register that is being adapted from South Africa. CDC will also provide short-

term TA to support HMIS activities, including supporting the rollout of the case registry, and PEPFAR

strategic information activities. These funds will also continue to support one local hire data manager at

CIDC.

The M&E Specialist recruited during FY 2008 will continue to provide technical assistance to the MOH and

CIDC M&E Unit. The contribution of the M&E Specialist to strengthening local human capacity in M&E has

been instrumental in building a culture of data use. The M&E Specialist will also develop a follow-up plan for

the training activities on M&E conducted during FY 2008 in collaboration with the MOH to ascertain the

performance of trainees who will benefit from the PEPFAR trainings related to M&E 101, economic

evaluation, qualitative evaluation, and data utilization to be delivered by CDC/Atlanta in coordination with

USG Rwanda staff.

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

GOR National Multi-sectoral Strategic Plan for HIV/AIDS Control (2005-2009) by directly supporting the

development of sustainable strategic information systems for the national HIV/AIDS program.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12910

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12910 2848.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $583,900

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

7264 2848.07 HHS/Centers for US Centers for 4358 1527.07 CDC Country $649,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

2848 2848.06 HHS/Centers for US Centers for 2598 1527.06 CDC Country $500,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $150,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $243,576

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY 2007, the need for a Systems Strengthening Advisor was identified to facilitate and advocate policy

changes needed to better implement PEPFAR. In FY 2008, this position, which is identified in staffing for

results, will: provide technical advice to the MOH and other GOR institutions on integrated and cost-

effective health policies related to health finance, human capacity development and training; assist the GOR

in coordinating/ consolidation of training activities, refresher courses and evaluation of training quality to

support HIV and other health programs; serve as a liaison between (and technical expert to) the private

sector and the donor community to ensure optimal use of resources and program activities/ strategies are

complementary. The advisor will work in close collaboration with various units of the MOH involved in the

provision of services for HIV affected or infected adults and children to identify, develop, update, finalize

and/or disseminate necessary HIV program policies and guidelines, training materials and job aids. For

example, finalization of the policies to allow whole blood draw by finger prick to be carried out by health

providers, to grant permission for minor children to be HIV tested without adult guardian present and for

Provider Initiated Testing and Care to be integrated into all health facilities. The advisor will continue to be

involved in policy agenda setting and following up on policy development in FY 2009 on behalf of USG.

Working in close collaboration with the USG and GOR colleagues, the advisor will support and coordinate

HIV-related training activities developed to facilitate program implementation at provincial, district and

facility level. Support to the Field Epidemiology and Laboratory Training Program (FELTP) will be a

particular focus in FY 2009. Additionally, working with the GOR, the advisor will develop a plan for re-

fresher training for all HIV program areas, develop criteria for selection of cadres of health care providers to

be targeted for each training activity. The advisor will work in close co-operation with the Ministry of

Education (MINEDUC) to ensure the MOH goal to include in-service training in the curriculum whenever

possible is realized. Developing a program to evaluate quality of training activities in collaboration with MOH

will also be conducted under this TA.

In close collaboration with both MOH and the USG Team, the advisor will,-through field visits, participation

in TWGs, discussions with partners and attendance at conferences and meetings- identify areas where

support is required within the healthcare sector to complement and expand HIV related activities in all levels

of the health sector in order to ensure a comprehensive approach to HIV services delivery. The advisor will

also function as a liaison between PEPFAR and the donor community in Rwanda to ensure complementary

of activities supported to maximize resource utilization and provide a comprehensive package of services at

central, district, facility and community levels. Finally, working closely with USG, GOR and implementing

partners in Rwanda the advisor will assist in the development of strategies to address program gaps.

Funds will allow the advisor to travel outside Rwanda be exposed to best practices and understand lessons

learned in other developing country's health systems. Equally dissemination of best practices in Rwanda to

countries in the region will be possible.

This position reflects program needs in line with "staffing for results".

In FY 2009, short term TA will also be required to support the systems strengthening program. In particular,

additional support for the SGBV orientation with police officers activity, integration of HealthQual into the

Health Sector and alignment of in-service training with pre-service curricula is anticipated.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16764

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16764 16764.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $300,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $150,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $50,000

Water

Table 3.3.18:

Funding for Health Systems Strengthening (OHSS): $145,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

As Rwanda implements a dramatic scale-up in program activities related to PEPFAR, there is a compelling

need for district level health personnel to increase the competencies in management and leadership. To

address that need PEPFAR Rwanda, in partnership with the Rwanda Ministry of Health (MOH), decided in

2007 to establish a management and leadership capacity building program in Rwanda. The objectives of

the program are to strengthen the district health system and to develop the institutional capacity in Rwanda

to deliver a public health leadership and management development program for district health personnel

that results in specific and measurable improvements in the efficiency and effectiveness of HIV/AIDS

programs and services and overall strengthens the public health system.

The Sustainable Management Development Program (SMDP) began program planning, development, and

implementation for a Rwanda-based program in 2008. During the planning process, key Government of

Rwanda (GOR) stakeholders, including the MOH and the National AIDS Control Commission (CNLS),

reiterated the need to tailor the program to meet the training needs associated with the GOR's policy of

decentralization. Specifically, the Rwanda SMDP will seek to bolster the managerial and leadership skills of

the district health teams that supervise and help coordinate activities carried out at the district, health

facility, and community levels.

Working closely with the National University of Rwanda School of Public Health (NUR/SPH) and Tulane

University, in FY 2009 the Rwanda SMDP will begin in-service training for 30 district health managers from

10 district health teams. Over the next 3 years, Rwanda SMDP will train district health teams among all 30

districts in Rwanda. During program development, the MOH identified the Rwanda SMDP as a vehicle for

institutionalizing and harmonizing management training skills for the GOR's district health teams along with

complementary online training programs such as the Virtual Leadership Development Program

implemented by MSH. Additionally, the GOR envisions the practical application of the Rwanda SMDP to

address priority issues, including: quality improvement for HIV, malaria, and TB service delivery; supervision

for data quality improvement; and solar energy management training.

For FY 2009, the in-country training will be conducted by three Rwandan trainers (consisting of two

NUR/SPH faculty members and one MOH official) who participated in SMDP's foundational five-week

training-of-trainers course in Atlanta, called Management for International Public Health (MIPH). During

MIPH and upon returning to Rwanda, these trainers will develop a curriculum that supports the GOR

priorities listed above. In FY 2010, three additional Rwandan trainers will attend MIPH and by year three of

the program, a cadre of 9 Rwanda-based trainers will be available to meet the future training needs for

Rwanda's district health personnel. The Rwanda SMDP will be a certificate-granting program under the

NUR/SPH and, in FY 2010, SMDP will initiate the development and integration of its curriculum for pre-

service training, supporting both GOR and PEPFAR strategies for sustainability.

The SMDP program objective is entirely consistent with the PEPFAR goal of strengthening human capacity

in a sustainable way. The program is also consistent with the GOR's Health Sector Strategic Plan.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16875

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16875 16875.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $145,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $145,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18:

Funding for Health Systems Strengthening (OHSS): $500,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

HIV/AIDS, tuberculosis (TB), avian influenza, and malaria are diseases of concern in Rwanda. In large

areas of the country, malaria is endemic predominantly due to P. falciparum, which exists throughout the

entire country during the whole year. Rwanda has several other diseases of epidemic potential including

cholera, dysentery, and meningitis. Cholera is almost endemic in areas around Lake Kivu. There is an

increasing threat of emerging infectious diseases due to Rwanda's proximity other countries where viral

hemorrhagic fevers are common.

There is currently only one trained epidemiologist and no field epidemiologists in the Rwandan public health

sector. As a result, Rwanda cannot afford to send away its key public health professionals for additional

long term training. The Rwanda FELTP will allow participants to serve the government at the national,

provincial, district and local levels while undergoing training. In addition, there is no training plan for public

health laboratory managers or veterinary field epidemiologists. This program will provide human capacity

development within the public health workforce to strengthen the capacity of Rwanda in applied

epidemiology, laboratory, and management across public health institutions The absence of trained field

epidemiologists has led to a weak surveillance system with delayed identification and understanding of

outbreaks because it relies primarily on information from front line health providers (nurses and medical

officers). This program will assist in strengthening the public health surveillance system, as well as

laboratory-based surveillance for infectious diseases.

The RFELTP is based on the model developed by the US CDC's 50-year history with Epidemic Intelligence

Service (EIS). This model was exported to other countries in the 1980's. There are currently several

programs in Africa—Ghana, Uganda, Tanzania, Kenya, Southern Sudan, Zimbabwe, and South Africa. The

South African and Tanzanian programs are supported by PEPFAR, as are the newly developing programs

in Ethiopia and Nigeria. The FELTP is ideally suited for building human capacity in Rwanda. As FELTP

trainees will remain in Rwanda during their training and afterwards they will continue to serve the Ministry of

Health at the national, provincial, district and local levels during their participation in the program. On

completion of training, the participants will function in positions that enable them to contribute to the public

health system both as leaders and trainers, thereby sustaining health program infrastructure in Rwanda.

The FELTP will use a multi-phased approach to address these gaps by: 1) conducting situational analysis

to identify management skills and performance gaps and to create an action plan for faculty and curriculum

development and institution-building; 2) training of a large pool of nationals in epidemiology, laboratory and

sound public health practice; 3) technical assistance by providing support to FELTP graduates in such

areas as conducting needs assessments, conducting in-country investigations and supervising applied

learning projects; and 4) ensuring sustainability by addressing such issues as local funding, and integrating

FELTP with other programs and program evaluation.

TRAC Plus - CIDC, along with the National Reference Laboratory (NRL) have been identified as "prime

partners" for the implementation of the RFELTP. These institutions are moving towards developing a

comprehensive national public health institution that is based upon the CDC model and consists of a

national reference laboratory, and epidemiologic support services for provincial and district level health

activities. In addition, the RFELTP will partner with the National University of Rwanda, School of Public

Health (NUR/SPH) to offer a masters level degree, with specializations in applied epidemiology, public

health laboratory management, or veterinary epidemiology to participants that successfully complete the

requirements of the program.

Since the RFELTP uses a multi-phased approach to development, planning and implementation activities

will occur over several years. As stated before, the first phase will concentrate on conducting situational

analysis to identify management skills and performance gaps and to create an action plan for faculty and

curriculum development and institution-building. The following activities will occur in FY09 in support of this

first phase.

1.Conduct a program development workshop designed to create the foundation for the program; serve as

guidelines for faculty, trainees, and program activities, while also ensuring that learning activities encourage

the acquisition of competencies

2.Providing short courses in field epidemiology and public health laboratory management for at least 30

participants per year from the district level and below. These courses will concentrate on enabling public

health professionals to gain skills in the latest laboratory techniques and technology, laboratory information

systems, and management practices to build laboratory capacity within Rwanda;

3.CDC will select Resident Advisors to guide this project and provide technical expertise. The Resident

Advisors will be located in Rwanda to provide support in developing and implementing training, advertising,

screening, interviewing, and selecting candidates for the RA position.

4.CDC and the Resident Advisors will provide technical assistance to the National Reference Laboratory

and TRAC Plus CIDC to enhance public health and laboratory systems and strengthening infectious

diseases surveillance, prevention, research, and control in Rwanda

5.RFELTP will identify field site locations throughout the various regions of Rwanda, especially the

problematic areas, to provide placements for the residents of the program. This will be accompanied by a

field supervisor workshop that will orient these persons so that they can be prepared to mentor and guide

the residents.

6.The RFELTP will recruit and select 5 field epidemiologists; 3 public health laboratory managers, 2

veterinary field epidemiologists and 1 veterinary laboratory manager, at Masters level. The first intake is

planned for January 2010, using a the Field Epidemiology and Laboratory Training Program method that is

based on the US CDC's EIS and has been implemented in over 30 other countries around the world.

In other PEPFAR countries, such as South Africa, Tanzania, Nigeria, Zimbabwe and Ethiopia, FELTP

programs have initially been financed by USG. In Zimbabwe, the program was started with USG and

Rockefeller funding, but has since be predominantly supported by the Government of Zimbabwe even

during the challenging economic times in that country. There are many other instances internationally such

as in Thailand and the Philippines, where this program was initially fully supported by USG, but later

became fully integrated into the public health system in terms of financial and human resources. The

FELTP model is designed to provide funding and technical resources for the first 5-10 years of the project,

Activity Narrative: while the program is being established. During this time, the program is becoming embedded within the

Ministry of Health on the organization chart, budget, and career path for human resources in the country.

More specifically the program will allow for:

•improved program monitoring and evaluation to achieve comprehensive evidence-based HIV disease

management services;

•improved quality data and data analysis (specific to person, place and time);

•functional laboratory services and information systems;

•improved laboratory QA and QC and training in support of VCT and HIV rapid testing methodologies; and

•improved monitoring for HIV related opportunistic infections and ART drug resistance.

•improved ability to address opportunistic diseases among Rwandans living with HIV/AIDS

•improved ability to address strategic information needs for HIV/AIDS, tuberculosis and malaria programs.

•strengthening local or local partner organizations, particularly in management, leadership and policy

development.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16877

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16877 16877.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $300,000

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $400,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18:

Funding for Management and Operations (HVMS): $1,382,601

Based on the second PEPFAR ‘Staffing for Results' exercise conducted in collaboration with USG PEPFAR

team for FY 2009, CDC is proposing to increase staff within technical and administrative areas by adding

three new positions. In addition, the terms of reference for two vacant positions have been redesigned to

better fit current needs. Specifically, the office is proposing to recruit a Pediatric HIV/AIDS Treatment

Specialist (2381), a Socio-Behavioral Specialist (2380), a Senior Statistician (2379), a Laboratory

Operations Coordinator (2378), and a Grants Manager (2382), to better support the implementation of

PEPFAR activities. The CDC will also fill the existing Senior Program Management Officer, Monitoring and

Evaluation Specialist, Basic Care Specialist positions. In addition to personnel costs, which include

Association of Schools of Public Health (ASPH) fellows and Comforce contractors, this activity includes

equipment and services to support general office operating expenses. In line with CDC's consolidation of IT

services, the program will purchase services from the new Information Technology Support Office (ITSO)

Infrastructure Services Support (ISS) package in order to improve operational effectiveness and efficiency.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12911

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12911 2844.08 HHS/Centers for US Centers for 6330 1527.08 CDC Country $791,601

Disease Control & Disease Control Office GHAI/TA

Prevention and Prevention

7260 2844.07 HHS/Centers for US Centers for 4358 1527.07 CDC Country $815,000

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

2844 2844.06 HHS/Centers for US Centers for 2598 1527.06 CDC Country $604,141

Disease Control & Disease Control Office GAP/TA

Prevention and Prevention

Table 3.3.19:

Cross Cutting Budget Categories and Known Amounts Total: $1,478,432
Human Resources for Health $126,000
Human Resources for Health $20,000
Human Resources for Health $60,000
Human Resources for Health $60,000
Human Resources for Health $87,432
Human Resources for Health $130,000
Human Resources for Health $50,000
Human Resources for Health $50,000
Human Resources for Health $150,000
Human Resources for Health $150,000
Education $50,000
Human Resources for Health $145,000
Human Resources for Health $400,000