PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
This is a continuing activity from FY 2008. No narrative required.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12887
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12887 8696.08 Department of United Nations 6326 4740.08 Refugees $16,407
State / Population, High UNHCR
Refugees, and Commissioner for
Migration Refugees
8696 8696.07 Department of United Nations 4740 4740.07 Refugees $35,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Refugees/Internally Displaced Persons
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $13,897
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Rwanda is host to nearly 52,000 refugees in four camps around the country. Refugee populations are
considered to be at higher risk for diseases as well as violence, economic and psychological distress. While
HIV prevalence rates in the camp populations in Rwanda was estimated at less than 3% in 2008 from a
data triangulation exercise, refugees interact regularly with members of surrounding communities where the
prevalence for HIV is much higher than the national average. Consequently, the refugee population should
continue to receive a comprehensive package of HIV prevention, care and treatment services.
Since FY 2005, PEPFAR has provided refugees with HIV/AIDS prevention and care services, providing
linkages and referrals to local health facilities for treatment and services that were not available on site. In
FY 2007, two of the camps began ART services and consequently were able to offer a full complement of
HIV services including prevention with positives (PWP) to over 30,000 refugees. UNHCR promotes AB
messages to the refugee community, including in- and out-of-school refugee youth, men, and vulnerable
women of reproductive age. These activities continue in FY 2008.
In FY 2009, UNHCR will continue to provide training to peer educators using AB materials adapted for the
refugee context. Interpersonal prevention activities that aim to increase youth access to prevention services,
such as AIDS support groups, life-skills training, school-based HIV prevention education, and community
discussions will also continue. Young girls in the refugee community, particularly female OVC who are
vulnerable to sexual abuse by older men, domestic violence, and sexual harassment at school will be
especially targeted under these activities. Messages will focus on abstinence and fidelity and also include
topics on the relationship between alcohol use, violence, stigma reduction and male norms. There will be
emphasis on changing the social acceptance of cross-generational and transactional sex
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.
Continuing Activity: 12888
12888 8700.08 Department of United Nations 6326 4740.08 Refugees $9,445
8700 8700.07 Department of United Nations 4740 4740.07 Refugees $52,000
Estimated amount of funding that is planned for Education $9,445
Table 3.3.02:
ACTIVITY IS MODIFIED IN THE FOLLOWING WAYS:
Continuing Activity: 12889
12889 8711.08 Department of United Nations 6326 4740.08 Refugees $4,723
8711 8711.07 Department of United Nations 4740 4740.07 Refugees $25,000
* Addressing male norms and behaviors
Table 3.3.03:
ACTIVITY UNCHANGED FROM FY 2008.
considered to be at higher risk for diseases as well as violence, economic, and psychological distress.
While HIV prevalence rates in the camp populations in Rwanda was estimated at less than 3% in 2008 from
a data triangulation exercise, refugees interact regularly with members of surrounding communities where
the prevalence for HIV is much higher than the national average. Consequently, the refugee population
should be monitored closely and they continue to require a comprehensive package of HIV prevention,
basic care and support (BCS), and treatment services.
Since 2005, PEPFAR has supported UNHCR and African Humanitarian Action (AHA) to provide HIV
prevention and care services in Kiziba refugee camp with linkages and referrals for treatment. FY 2009
funding for this activity will continue support the provision of BCS services to 200 PLHIV and the training of
48 health providers, laboratory technicians, and community volunteers in Kiziba refugee camp health clinics
and communities.
UNHCR/AHA 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 BCS 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 PEPFAR clinical partners, UNHCR/AHA will work with the
Karongi DHT 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/AHA 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 BCS and OI drugs, laboratory supplies and
diagnostic kits. UNHCR/AHA 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.
This activity supports the PEPFAR five-year strategy by providing prevention, care, and treatment to
vulnerable and high-risk populations.
Continuing Activity: 12890
12890 8718.08 Department of United Nations 6326 4740.08 Refugees $8,204
8718 8718.07 Department of United Nations 4740 4740.07 Refugees $44,000
Estimated amount of funding that is planned for Human Capacity Development $1,000
Table 3.3.08:
THIS IS A CONTINUING ACTIVITY FROM FY 2008, ALREADY APPROVED
Continuing Activity: 12893
12893 8737.08 Department of United Nations 6326 4740.08 Refugees $103,365
8737 8737.07 Department of United Nations 4740 4740.07 Refugees $88,000
Table 3.3.09:
funding for this activity will continue support the provision of BCS services to children living with HIV and the
training of 48 health providers, laboratory technicians, and community volunteers in Kiziba refugee camp
health clinics and communities.
HIV-positive children and infants, and referrals to community-based BCS services. Infants born to HIV-
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.10:
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $5,083,937
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Tuberculosis (TB) continues to be a significant health problem in Rwanda, particularly for persons living with HIV. Since 1990,
expansion and enhancement of DOTS as part of the 6 point "Stop TB Strategy" has been implemented in Rwanda by the National
TB Program (Programme Nationale Integer de Lutte Contre Lepere et la Tuberculose - PNILT). In 2007, there were 8,014 new
TB cases, of which 4,053 (50.6%) were smear-positive pulmonary cases. With PEPFAR support, and in conjunction with national
and international partners, TB treatment success rates have increased from 58% in 2003 to 86% in 2006. In 2007, overall TB and
smear-positive case notification rates were 91 and 46 per 100,000 persons, respectively. Rwanda has 100% DOTS coverage in
all health facilities that offer TB services.
With USG support, the PNILT began implementing a national TB/HIV surveillance system. In FY 2007, 8,014 patients with TB
were registered and 85% were HIV-tested. Thirty-eight percent of these patients tested positive for HIV and of these patients with
TB disease and HIV infection, 61% received cotrimoxazole and 39% received ART. By the second quarter of FY 2008, the HIV
status was known for 95% of patients registered by the TB program. Among the registered patients with TB disease, 36% were
found to also be infected with HIV. Among those patients with TB and HIV, 84% were given cotrimoxazole and 43% accessed
ART.
Addressing TB/HIV co-infection through program collaboration and integration of services is a priority of the Rwandan
government. Implementation of TB/HIV collaborative activities began with the placement of a TB technical advisor and
coordinators at PNILT and the Treatment and Research AIDS center (TRAC-Plus) to establish national level coordination. In
February 2005, key stakeholders from the MOH and partner organizations held a workshop to jointly prioritize collaborative
activities and establish a national TB/ HIV integration working group. In October 2005, the MOH approved a national policy on
TB/HIV collaborative activities based on WHO interim policy.
To promote intensified case finding, a TB screening tool was developed to be administered with all patients at the time of
enrollment in HIV care and treatment services and at routine follow-ups. Patients are first screened for TB related symptoms. If
any symptoms are present, a TB diagnostic evaluation follows that consists of sputum smear and chest radiograph examination.
If active TB is diagnosed, patients are referred for TB treatment elsewhere. This checklist has been included in national pre-ARV
and ARV registers. A survey completed by TRACPlus at 18 health facilities in 2008 showed that among PEPFAR-supported sites
with available data, TB screening rates at time of enrollment ranged from 37 - 100%. Reliable national level data are not currently
available.
Since 2007, diagnostic methods have been improved for diagnosing TB among patients living with HIV. With USG support, the
National Reference Laboratory (NRL) has improved culture capacity for detection of M. tuberculosis and drug susceptibility
testing. PEPFAR funding is also supporting laboratory technical assistance, infrastructure improvements, and pre-service training
for laboratory technicians in Kigali and the Butare regional laboratory. Diagnostic capacity was enhanced by numerous training
activities which were carried out and followed-up with regular supervision. Doctors were targeted as a priority group and all the
district hospitals currently retain doctors trained in tuberculosis control and chest radiography with emphasis on atypical
presentations of lung disease among PLHIV. Despite significant progress, the GOR, PEPFAR and WHO have identified
numerous challenges in integrating and coordinating services. For example, the recent efforts to decentralize health care services
have resulted in a lack of sustained political commitment to support TB/HIV collaborative activities at all levels. Progress is also
noteworthy with regard to the management of multi-drug resistant tuberculosis (MDR-TB). A growing number of health facilities
are involved in the follow-up and ambulatory treatment of patients with MDR-TB. Guidelines outlining MDR-TB treatment were
published and disseminated in 2007. Eighty-six patients were started on second-line treatment during 2007. Data from PNILT
show that of the 119 TB isolates tested in 2007, 89 (75%) were MDR and 39 (45%) of diagnosed cases of MDR occurred in
people living with HIV. The cure rate for the first cohort of cases enrolled in 2005 was of 82%. In FY 2009, PEPFAR will support
a survey of MDR TB in prisons.
In FY 2009, the priority will be to expand implementation of regular TB screening to all ART sites. For patients suspected of
having TB the priority is to ensure adequate diagnosis and completion of treatment with DOTS. In order to improve integration of
activities, the USG will support training of all TB providers in HIV care; including clinical staging, CD4 testing, cotrimoxazole
provision, and management of other opportunistic infections. USG activities will continue to support HIV-testing of all patients with
TB and ensuring access to care (including cotrimoxazole, assessing clinical stage and CD4 count) and ART as appropriate. USG
will also work to promote and support national level coordination and supervision of TB and HIV programs.
In FY 2009, the goal is to ensure TB/HIV collaborative activities by scaling up "One-stop service" for TB-HIV management.
Reaching full coverage of "one-stop service" for TB patients with HIV, i.e. allowing TB patients to initiate ART and receive other
HIV care in TB settings, is especially important at TB diagnostic and treatment centers without HIV services within the same
facility. Training of providers, visits to model centers (Gisenyi District Hospital and Kicukiro Health Center), supervision, and
mentoring are critical activities to enable national scale-up of integrated TB-HIV activities.
In FY 2009, an additional priority for PEPFAR activities is to continue to expand clinical and laboratory capacity to diagnose extra-
pulmonary TB. PEPFAR supported AIDSRelief/IHV is providing clinical mentoring and building pathology laboratory capacity at
CHUK and the University of Rwanda National Pathology Laboratory. AIDSRelief/IHV is providing training for laboratory
technicians on fine-needle aspiration of lymph nodes and equipping laboratories with materials and supplies necessary for
diagnosing extra-pulmonary TB.
In FY 2009, PEPFAR will support the implementation of key policy areas for TB infection control activities in Rwanda to reduce the
likelihood of TB transmission in health care facilities. Policy areas include 1) managerial and administrative policies, 2)
environmental controls in high risk areas or for high risk procedures in the health facilities, and 3) reduction of diagnostic and
treatment delays to minimize transmission and improve treatment outcomes for patients with TB. In FY 2009, PEPFAR Rwanda
will support priority TB-HIV basic program evaluations, such as evaluation of TB screening of HIV care and treatment patients
during follow-up and prevalence of TB-HIV co-infection in prisons.
Table 3.3.12:
should be monitored closely and they continue to require a comprehensive package of HIV prevention, care
and treatment services.
Since 2005, PEPFAR 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 UNHCR began implementing the national TB/HIV policy and guidelines at their three supported
sites. 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. In FY 2009, UNHCR/ARC will continue 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 supported 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.
HIV services are not yet available at all facilities in Rwanda. In order to ensure effective integration of TB
and HIV UNHCR/ARC is supporting integrated planning and TB/HIV training to both HIV services providers
and TB services providers. This 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 2009 UNHCR/ARC will continue to support three existing sites for the implementation of the TB/HIV
component of the clinical package of HIV care. Lessons learned from integrating TB and HIV will serve in
integrating HIV into the primary healthcare
Continuing Activity: 12891
12891 8670.08 Department of United Nations 6326 4740.08 Refugees $16,407
8670 8670.07 Department of United Nations 4740 4740.07 Refugees $23,420
Estimated amount of funding that is planned for Human Capacity Development $5,000
Continuing Activity: 12892
12892 8732.08 Department of United Nations 6326 4740.08 Refugees $19,688
8732 8732.07 Department of United Nations 4740 4740.07 Refugees $40,000
* Reducing violence and coercion
Table 3.3.14:
