AIDSRelief is a comprehensive anti-retroviral therapy program in ten countries over sub-Saharan African and the Caribbean. In Rwanda, AIDSRelief is providing antiretroviral treatment to more than 3,721 people, including 524 children. Based on its successes and lessons learned from the past year of project implementation, the AIDSRelief program in Rwanda will continue to expand access to treatment services to reach 4,972 patients on ART by the end of February 2011.

The goal of this Consortium is to ensure that people living with HIV/AIDS have access to quality HIV care and treatment and that they are supported for adherence to ART that assures viral suppression. AIDSRelief intends to expand, on a sustainable basis, the provision of ART to the greatest number of needy patients in these ten countries, consistent with good medical science, national priorities and programs, and cost-effective deployment of program resources. In this regard, AIDSRelief is committed to work in close collaboration with the Government of Rwanda and the in-country US government team to help strengthen the infrastructure of the MOH in general, through increasing liaison with the District Health Team, and specifically, the capacity of the health staff of its points of service to provide quality antiretroviral therapy.

AIDSRelief has established a multi-disciplinary technical assistance team for Rwanda, the Country Technical Coordinating Team (CTCT), which is responsible for overseeing the implementation of the

program. The CTCT includes people with expertise in HIV/AIDS clinical care for adults and children, palliative care, patient adherence, laboratory diagnostics, prevention of mother-to-child transmission, drug procurement and pharmaceutical services, financial and grant compliance, and the management of strategic information. Together with corresponding sections of the Government of Rwanda, the Ministry of Health/TRAC and the in-country US Government team, the CTCT of AIDSRelief will make an impact on this epidemic, for the benefit of all persons now living with HIV/AIDS in Rwanda.

AIDSRelief is contributing to the achievement of Partnership Framework goals through its activities notably the expansion of the geographical coverage in Nyamasheke District, the improvement of the quality of the comprehensive HIV Treatment, care and support provided; and the strengthening of national staff expertise on HIV Prevention, Treatment, Care and Support at National, District and Health facility levels:

• AIDSRelief has expanded its HIV services from 3 to 20 LPTFs in Nyamasheke and Burera districts within the past four years. • As of October 31, 2009, the program has enrolled 9,722 patients in care, of which 3,721 are on ARV treatment. Overall, there has been over a 34% increase in both care and treatment enrollment between FY08 and FY09. • AIDSRelief has strengthened staff capacity for the use of the new PMTCT protocol, focused on evidence-based maternal and pediatric HIV care; trained and mentor site staff on early HIV diagnosis (DBS, clinical) and provided transition feeding assistance to exposed Infant. • At all AIDSRelief supported sites, PLHIV systematically receive opportunistic infection prophylaxis, treatment and other co-infection treatment according to national guidelines. • An effective system was put in place by AIDSRelief with facility-based case managers, health community leads, health care workers, and community-based volunteers to ensure continuum coverage and quality of basic care and psychosocial support to PLHIV with contributes to reduction of stigma and discrimination of PLHIV and OVC in the community. • In collaboration with CAMERWA and SCMS, AIDSRelief provided TA to health facilities to ensure the availability and rational use of quality drugs and commodities.

AIDSRelief is supporting 20 Health Facilities including 19 (17 health centers, 2 district hospitals) in Nyamasheke District, Western Province serving a population of 353,207 and one health center in Bungwe Sector in Burera District Northern Province serving 24,810 inhabitants.

AIDSRelief is contributing to health system strengthening at all levels. Staff at Health facilities received intensive clinical training and mentoring, training on data management and use of IQChart software for patient management and monitoring, technical support on finance, compliance and administration. At

community level, AIDSRelief emphasized on community outreach and home care through PLVIH association, community health leads and volunteers. As part of AIDSRelief Rwanda's commitment to build the national capacity in HIV care and treatment services, AIDSRelief has been working closely with government counterparts, TRAC Plus-CIDC and the National Reference Laboratory (NRL), training and mentoring over 150 health professionals. Training contents ranged from basic HIV care and treatment to strengthening the capacity for diagnosis of extra pulmonary TB among PLVIH.

To ensure monitoring and evaluation of the planned activities, AIDSRelief will strengthen monitoring and data management systems, for collecting, managing and analyzing clinical data at LPTFs, work with TRAC Plus in providing technical assistance to the sites to integrate, modify and improve their existing medical records system to meet the reporting requirements of TRAC PLUS/MOH, donor and other stakeholder.

With TRAC Plus/MOH, AIDSRelief will continue to identify areas of system strengthening in term of strategic Information to enable organizations to enhance and sustain HIV service delivery and promote integration of supervision, mentoring activities with district hospitals' support teams and TRAC/MOH mentoring teams, through the on-going assessment of local partner's strengths and weaknesses in the area regarding strategic information as a part of on-going mentorship.

In FY10, AIDSRelief will continue to provide technical support to PEPFAR partners using IQChart (International Quality Clinical HIV/AIDS Registry Tool), mentors Monitoring and Evaluation officers on the updated version of IQChart containing PMTCT, OIs and STIs indicators and support the National Strategic Information Technical Working Group in process of rolling out the new HIV data management system and Partnering with MoH on the EMR and HMIS working group.

AIDSRelief will continue to build the data quality culture of LPTF staff to ensure quality (clean, complete and valid) of chronic care data through Data Quality Audit mentoring activities at District and LPTFs level. Continue to support CTCT in defining clinical indicators for LPTF in order to address gaps in program and services in providing local partners with data analysis tools and methods, and build capacity at LPTF in data collection and analysis (IQChart)

AIDSRelief Strategic information staff will continue to build LPTFs capacity to ensure compilation and timely submission of reports required by stakeholders & donors including TRACPLUS, CDC, OGAC and other LPTF & CTCT specific reports. In accordance to transition to local partner strategy, the SI team will provide relevant Technical Assistance to ensure LPTFs receive information in timely manner and are able to generate their own reports, Continue Technical Capacity transfer to local partners that will focus on

reinforcing data management capacity and monitoring, building data demand and information use (DDIU) so that local partners can generate their own reports, thereby enhancing data ownership (Sustainability). SI team and District health Directorate team to develop a plan and outline activities that promote the use of SI to enhance Local Partner service delivery.

Using paper registers, Electronic Data management system IQChart, by supporting data manager and community support staff, to monitor routine CD4 follow up, patient appointment adherence and tracing patient lost to follow-up to address HIV patient retention and use of other patient-level data to improve programmatic operations.

AIDSRelief will continue the mentorship on IQChart in LPTFs to strengthen their capacity to accurately collect, enter, store and retrieve program data for use in planning, monitoring, reporting, and improving quality, and demonstrated ability to fulfil GOR/MOH and donor reporting requirements. AIDSRelief will continue the ongoing Information Technology support (Computer Software and Hardware troubleshooting, including anti-virus update) in all LPTFs

In collaboration with TRAC Plus and Measure Evaluation project, promote DDIU (Data Demand and Information Use) at National, District and LPTFs level. Continue the mentorship for capacity building of LPTF staff to ensure they can manage and maintain the health management information system.

This is a continuing activity from FY09.

In FY09, AR supported 16 ART sites and provided ART services to 3,197 adults patients on ART as of October 31 and expect to reach 3,390 patients actively on ART by the end of February 2009. In FY10, AR will continue to provide ARV services for 1,909 existing patients and 692 new patients at 11 ART supported sites. Nevertheless AR will continue to support the 5 transitioned ART sites for quality treatment for 1,481 existing patients and 434 new patients. AR will continue to support LPTF to enroll patients tested positive in treatment by rapidly check for CD4 count, initiate treatment and actively support evaluation of patients on ART for eventual treatment failing as to provide them with appropriate ART treatment. In collaboration with the district hospital team, regular follow-up visits will be made to these sites. Clinicians from the district team will review ART and non-ART complicated cases. Nurses at these sites will continue to be trained and mentored for provider- initiated-testing, to follow-up patients, and to detect and refer complicated cases to district hospitals. Supported by international technical assistance, AR will continue to support Quality Improvement with a review of indicators, medical dossiers and viral load measurements to develop and strengthen clinical capacity for more efficient and quality-assured patient management. AR will ensure participation in the District Health Team meetings by health center staff, country program staff for better collaboration. AR will work with the National Reference Laboratory to expand the diagnostic resources for HIV at the sites. AR will work to improve reporting linkages with CAMERWA and to continue mentoring health center staff in their ability to receive, manage, and forecast the needs for ARVs and drugs for OI and palliative care.

PBF is a major component of the Rwanda EP strategy for ensuring long-term sustainability and maximizing performance and quality of services. In coordination with the national HIV PBF project and according to the new support approach, in improving key national HIV performance and quality indicators, CRS will shift its support of output financing based on sites performance to a technical participation on health facility performance evaluations and on PBF technical extended team meetings. Full or partially reduced payment of palliative care and other indicators is contingent upon the quality of general health services as measured by the score obtained using the standardized national Quality Supervision tool. DHTs is now playing a critical role in the oversight and management of clinical and community service delivery. AR will strengthen the capacity of two DHTs to coordinate an effective network of palliative care and other HIV/AIDS services. The basic package of financial and technical support includes staff for oversight and implementation, transportation, communication, training of providers, and other support to carry out key responsibilities.

In FY09, AR has effectively started rolling-out the Pilot Program to Strengthen Delivery of Services to

Victims of Sexual Violence at 3 supported sites according to national guidelines. The pilot program aims to strengthen a comprehensive response to cases of sexual violence with a focus on clinical management and the role of the health facility as both a place of referral from the police and the community and a referrer to other services including more extensive psychosocial and trauma counseling, legal assistance, temporary shelter, and longer-term reintegration of the victim into the community. AR provided training on comprehensive management of SGBV clients to clinical staff, counselors, CST and community health workers of those 3 pilot sites but also to other supported sites and participated in the development of the national SGBV guidelines, workplan and budget.

In FY10, AR will continue to support the 3 pilot sites and expand its support to other 17 sites by providing refresher training and mentoring to clinical staff, providing clinical equipment, drugs and PEP kits, IEC and reporting tools. In collaboration with the district hospital staff, AR will support and conduct ongoing quality assurance and supportive supervision for health providers. The community role will be strengthened in order to improve access of victims to quality services through refresher training for community support team and community health workers and sensitizations and creation of support groups for SGBV survivors facilitating their integration in the community. Linkages between clinical services (PMTCT, VCT, ART, etc) and other sexual violence services will be strengthened for an effective support to victims through a reinforcement of the existing referral and communication system. AR will also participate actively in the strengthening of the SGBV national coordination and response.