Rwanda is host to approximately 53,000 refugees in three refugee sites around the country. Refugee populations are considered to be at high risk of infectious disease, in particular HIV, as well as SGBV and its associated consequence and psychological distress.

UNHCR has been benefiting from PEPFAR funds since 2007 to implement a comprehensive HIV/ AIDS program in Kiziba refugee site located in Kibuye district/sector. Based on the successes and lessons learnt from the past years of project implementation UNHCR through its partner will continue to strengthen the implementation of HIV/AIDS program in the Kiziba refugee site.

The goal of this program is to ensure that refugees and host communities living with HIV/AIDS have

access to HIV information, quality HIV care and treatment services as well as supporting a successful Anti Retroviral Treatment adherence that assures viral suppression. UNHCR will continue to support trainings on a sustainable basis, provision of HIV/AIDS messages, basic care and treatment to HIV, TB and OIs to the greatest number of needy refugee patients and in the hosting community, consistent with PEPFAR strategy and GOR national priorities.

UNHCR will continue to strengthen and support the provision of HIV health care services ranging from prevention, care and treatment to refugees and hosting community.

To achieve these activities, UNHCR will strengthen staff capacity to use new guidelines/standards and protocols adopted by both UNHCR/GOR through conducting trainings, mentoring at different levels of implementation.

UNHCR is committed to working in close collaboration with the Government of Rwanda, UN agencies and NGOs to strengthen its support to HIV care, support and treatment to refugees and the hosting community.

To ensure monitoring and evaluation of the planned activities, UNHCR will strengthen monitoring and data management systems, for collecting, managing, and analysis of clinical data at the health facility, strengthen feedback mechanism for better performance.

This is a continuing activity from FY 2009.

Kiziba Refugee Camp is host to approximately 19,000 refugees. Refugee populations are considered to be at higher risk of infectious disease, and HIV in particular, as well as GBV and other forms of violence, and economic and psychological distress.

In FY 2009 UNHCR partners provided basic care and support to 122 HIV positive adults. This package of services included Co-trimoxazoleprophylaxis and nutrition counseling.

In FY 2010, UNHCR partners will focus on the basic care package, which includes preventive care services, clinical care, psychological, spiritual and social support services, CTX prophylaxis for eligible adults, and prevention counseling for positives.

In FY 2010 UNHCR partners will provide basic care services to 200 adults and strengthen nutritional services, including nutritional assessment, and nutrition counseling. UNHCR partners 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, and the maintenance of medical records for all HIV-positive adults.

In collaboration with USAID clinical partners and Columbia University, UNHCR partners will work with the Byumba, Kibuye, and Ngarama DHTs to ensure that health clinic providers receive training or refresher training on basic management of adults living with HIV/ AIDS, including training on ART adherence support. UNHCR partners will monitor and evaluate basic care activities through ongoing supervision, quality assurance, and data quality controls, and will continue to build the capacity of local refugee health care providers to monitor and evaluate HIV/AIDS basic care activities through the strengthening of routine data collection and data analysis.

In Kiziba Refugee Camp, UNHCR partners will, through CAMERWA, procure and distribute palliative care and OI drugs, laboratory supplies and diagnostic kits. UNHCR will construct a new morgue at the site.

UNHCR partners will continue to support the continuation of care through the establishment of referral and tracking systems for comprehensive basic care and support services for adults living with HIV/AIDS. UNHCR partners will continue to work with their respective district hospitals to ensure an ongoing system

of referrals and care between camps and other health services, such as transport of blood specimens for CD4 testing, management of complicated OIs, and periodic monitoring of ART patients.

UNHCR will provide technical support and monitoring of partners' activities and data collection, and ensure appropriate reporting through strengthening coordination meetings with HIV/AIDS focal point.

PBF is a major component of the Rwandan strategy for ensuring long term sustainability and maximizing performance and quality of services. In coordination with the national HIV/PBF project, UNHCR partners will shift their support from output financing based on site performance to participation in health facility performance evaluations and on PBF technical teams. UNHCR will strengthen the capacity of health care providers in the camps to coordinate an effective network of adult care and support services. The basic package of financial and technical support will include implementation guidance, transportation, communication, and training of providers.

This is a continuing activity from FY 2009

Kiziba Refugee Camp is host to approximately 19,000 refugees. Refugee populations are considered to be at high risk of infectious disease, in particular HIV, as well as GBV and other forms of violence, and economic and psychological distress.

As of FY 2010, UNHCR partner will focus on the care and treatment full package of adult care and treatment services, provision of ART for eligible adults in line with national guidelines. UNHCR partner will continue to provide care and treatment services to adults and strengthen nutritional services, including nutritional assessment, and nutrition counseling.

UNHCR partner will ensure the provision of routine clinical staging and systematic CD4 count testing, medical records for all HIV-positive adults. Co-trimoxazole prophylaxis will be provided to all eligible HIV positive adults.

In collaboration with USAID clinical partners and Columbia, UNHCR partner will work with the Kibuye DHTs to ensure that health clinic providers receive training or refresher training in management of adults living with HIV/AIDS including training on ART adherence support. UNHCR partner will monitor and evaluate care and treatment activities through ongoing supervision, quality assurance, and data quality

controls, and will continue to build the capacity of local refugee health care providers to monitor and evaluate HIV/AIDS care and treatment activities through ongoing strengthening of routine data collection and data analysis.

UNHCR partner will continue to support the continuation of care and treatment through the establishment of referral and tracking systems for comprehensive care and treatment services for adults living with HIV/ AIDS. UNHCR partner will continue to work with the respective district hospitals to ensure an ongoing system of referral and treatment between the camps and other HIV health facilities, such as transport of blood specimens for CD4 count testing and management of complicated OIs, and periodic monitoring of ART patients.

UNHCR will provide technical support and monitoring of IP activities and data collection, and ensure appropriate reporting through strengthening coordination meetings with HIV/AIDS focal points.

PBF is a major component of the Rwandan 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 Adult care and treatment performance and quality indicators, UNHCR will swift it support of output in financing based on site performance to a technical participation on health facility, performance evaluations and on PBF technical extended team meeting. UNHCR will strengthen the capacity of the health service providers to coordinate an effective network of adult care and treatment services. The basic package of financial and technical support will include technical support, implementation, transportation, communication, training of services and other supports to conduct key responsibilities.

This is a continuing activity from FY 2009

In FY 2010, UNHRC through its implementing partner American Humanitarian Association (AHA) will use a strategic mix of targeted PIT (Provider Initiated Testing), family centered and client-initiated CT services that ensure confidentiality, minimize stigma and discrimination, and reach out to those individuals most likely to be infected.

This activity will support CT services at Kiziba Refugee Camp. PIT services will target adults and pediatric in-patients presenting with OIs and TB symptoms, malnourished children, HIV-exposed infants

and STI. Moreover community workers will be trained as counselors in order to provide continuous support beyond the consultation to encourage testing acceptance, family and or partner tracing and support to those who receive their test results.

UNHCR/AHA will support six CT providers to continue to provide traditional CT (client initiated) services for clients who wish to know their status in particular for discordant couples, ANC male partners and youth. Counseling messages will emphasize prevention including abstinence, fidelity, and alcohol reduction, SGBV sensitization, disclosure of test results and follow-up.

UNHCR/AHA will strengthen and ensure that HIV-positive patients are provided with patient education, positive living counseling and referral for community based services such as IGA through PLWHA associations, OVC, and home based care programs.

At the health facility level, partners will ensure a system for supportive supervision for nurses and counselors including training of staff in support supervision for CT, use of quality control check list and data control.

PBF is a major component of the Rwandan strategy for ensuring long term sustainability and maximizing performance and quality of services. In coordination with the national HIV/PBF program and according to the new support approach in improving key national VCT performance and quality indicators, UNHCR/AHA will swift its' support of output financing based on site performance to a technical participation on health facility, performance evaluations and on PBF technical extended team meeting.

UNHCR/AHA will strengthen the capacity of health service providers in Kiziba to coordinate an effective network of VCT services. The basic package of financial and technical support will include technical support, implementation, transportation, communication, training of service providers and other supports to conduct key responsibilities.

This is a continuing activity from FY 2009.

Kiziba Refugee Camp is host to approximately 19,000 refugees. Refugee populations fall among vulnerable groups exposed to epidemics and different kinds of social abuse. Particularly, they are susceptible to HIV, GBV, economic and psychological distress.

As of FY 2010, UNHCR through its implementing partner, American Humanitarian Association (AHA) will focus on the provision of the basic care package including a full range of pediatric preventive care services: Co-trimoxazoleprophylaxis (CTX) for 30 eligible children and exposed infants in line with national guidelines; clinical care; psychological, spiritual and social support services; and prevention and counseling for positives. UNHCR/AHA will strengthen nutritional services, including nutritional assessment, nutrition counseling, and management of malnutrition through provision of micronutrients and multivitamin supplements for clinically eligible malnourished children and infants.

UNHCR/AHA will ensure the provision of, or referrals for diagnosis and treatment of opportunistic infections (OI) and other HIV-related illnesses (including TB), routine clinical staging and systematic CD4 testing, and medical records for all HIV-positive infants. 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 USAID clinical partners and Columbia, UNHCR/AHA will work with the Byumba, Kibuye, and Ngarama district health teams (DHTs) to ensure that health care providers receive training or refresher training in basic management of children and infants, including training in the identification and management of pediatric HIV cases, in ART adherence support, and in the identification and management of treatment failure cases. The trainings will also include the new national pediatric treatment guidelines. A specific emphasis will be put on early infant diagnosis and on the implementation of a reliable and efficient sample transportation system. Moreover, UNHCR/AHA will assist DHTS in mentoring children and adolescent support groups that have been established at the sites as a component of psychosocial support for HIV-positive children and adolescents. These clubs will be used to provide ongoing support for children in care and on treatment or affected by HIV, and assist with addressing issues around status disclosure and treatment adherence. One child counselor per ART site will be trained to organize children support groups that will help providing psychosocial support to children and adolescents.

UNHCR/AHA will monitor and evaluate basic care activities through ongoing supervision, quality assurance, and data quality controls, and 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 analysis.

UNHCR/AHA will procure and distribute through CAMERWA all palliative care and OI drugs, laboratory supplies and diagnostic kits.

UNHCR/AHA will continue to support the continuation of care through the establishment of referral and

tracking systems for comprehensive basic care and support services for pediatric HIV-positive and exposed infants. UNHCR/AHA will continue to work with the respective district hospitals to ensure an ongoing system of referral and care between the camps and other HIV care and support services, such as transport of blood specimens for CD4 and PCR testing, management of complicated OIs, and monitoring of ART pediatric patients.

This is a continuing activity from FY 2009.

Kiziba Refugee Camp is host to approximately 19,000 refugees. Refugee populations fall among vulnerable groups exposed to epidemics and different kinds of social abuse. Particularly, they are susceptible to HIV, GBV, economic and psychological distress.

In FY 2010, UNHCR, through its implementing partner American Humanitarian Association (AHA), will continue to strengthen its support to eligible children at the Kiziba refugee site and the host community. HIV-positive children will be provided clinical monitoring and staging for ART. In collaboration with USAID clinical partners and ICAP (Columbia University), the UNHCR partner will work with the Kibuye DHTs to ensure that health service providers receive training or refresher training in basic management of infants born to HIV-positive mothers, including training in ART adherence support and the identification and management of HIV-positive infants. UNHCR/AHA will assist heath providers in mentoring children and adolescent support groups that are established at the sites as a component of psychosocial support for HIV-positive children and adolescents. These clubs will be used to provide ongoing support for children in care and on treatment, and to assist with addressing issues around treatment adherence.

UNHCR/AHA will monitor and evaluate pediatric HIV activities through ongoing supervision, quality assurance, and data quality controls. It will continue to build the capacity of local refugee health care providers to monitor and evaluate pediatric HIV/AIDS activities through strengthening of routine data collection and analysis for basic care.

UNHCR/AHA will procure and distribute through CAMERWA all drugs for basic care and support, drugs for opportunistic infections (OI), and laboratory supplies and diagnostic kits. UNHCR/AHA will work to ensure appropriate storage, management and tracking of commodities.

UNHCR/AHA will continue to support the continuum of care and treatment through the establishment of

referral and tracking systems for comprehensive pediatric HIV patient management and support services. UNHCR/AHA will strengthen linkages between basic care and support, TB and ART services at the Kiziba refugee site and for the hosting community. UNHCR/AHA will continue to work with the Kibuye district hospital to ensure a functioning referral and counter-referral system between the camp and health facilities providing HIV care and treatment. UNHCR partner will also ensure the monitoring of infants on ART.

UNHCR/AHA will provide technical support and monitoring of AHA's activities particularly in data collection, and appropriate reporting.

Performance-based financing (PBF) is a major component of the Rwandan PEPFAR strategy for ensuring long term sustainability and for maximizing performance and quality of services. UNHCR/AHA will continue to support PBF through direct collaboration with MOH's , input technical assistance and output performance-based financing (PBF). The basic package of financial and technical support will include support for implementation, transportation, communication, training of health care providers, and other type of support for HIV-related pediatric health interventions among the refugee population.

This is a continuing activity from FY 2009.

Kiziba Refugee Camp is host to approximately 19, 000 refugees. Refugee populations are at higher risk of diseases, particularly HIV, as well as other forms of violence, economic and psychological distress. While the program has been ongoing in Kiziba camp, there is still need to strengthen the program among the refugee populations and host community in Kiziba.

In FY 2010, UNHCR will continue to promote AB messages to the refugee community, including refugee youth in- and out-of-school, men, and vulnerable women of reproductive age living in Kiziba refugee camp and the hosting community.

UNHCR will continue to train or, as necessary, provide refresher training to 25 health staffs and peer educators using AB materials adapted for the refugee context. UNHCR will support interpersonal prevention activities that aim to increase youth access to prevention services, such as anti-AIDS clubs, life-skills training, school-based HIV prevention education, and community discussions. Messages delivered will not only focus on abstinence and fidelity, but will also include topics on the relationship

between alcohol use, violence, HIV, and stigma reduction. Young girls in the refugee community, particularly female OVC, are vulnerable to predatory sexual behaviors of older men, as well as child sexual abuse, domestic violence, and sexual harassment at school. Prevention efforts under this activity will focus on changing social acceptance of cross-generational and transactional sex.

Key influential community members such as traditional and religious leaders and refugee camp leaders will also reinforce the messages of abstinence, delayed sexual debut, being faithful, reduction of GBV and responsible consumption of alcohol. As many risky behaviors can often be linked to other contextual factors such as unemployment, poverty, trauma, and psychosocial needs, UNHCR will strengthen referrals mechanisms, coordination and networking with other partners to provide refugee clients and their family members access to IGA, OVC programs, food support, vocational training, trauma counseling, legal support, and mental health care.

UNHCR will strengthen its support to community structures to create opportunities for exchange and peer support, linkages to IGA and vocational training, promotion of healthy RH behaviors, and psychosocial support and counseling.

This activity addresses the key legislative issues of gender, stigma and discrimination through HIV/AIDS BCC messages, and linking to other sectors for strengthening income-generation opportunities and access to food support for vulnerable refugee women, girls and their families.

This activity reflects the priorities of the PEPFAR strategy and the GOR national prevention plan by reaching vulnerable and high-risk groups with HIV prevention, care, and treatment services.

This is a continuing activity from FY 2009.

Kiziba Refugee Camp is host to nearly 19,000 refugees. Refugee populations are considered at higher risk for diseases, particularly HIV, as well as other forms of violence, economic and psychological distress.

In FY 2010, with PEFAR support, UNHCR through its implementing partner American Humanitarian Association (AHA) will continue to support activities in Kiziba Refugee Camp. BCC will target 80 high- risk and vulnerable refugee populations and use anti-HIV/AIDS clubs, peer educators, community

forums, and relevant IEC materials. Key messages will promote risk reduction behaviors, condom use, and address social norms, GBV, and alcohol abuse.

To monitor and track the reach of these messages and condom uptake, UNHCR will integrate program- level indicators, including DELIVER-supported condom distribution and tracking indicators into existing reporting forms and tools.

This activity reflects PEPFAR priorities and the GOR National Plan for HIV Prevention by strengthening integrated health communication campaigns to prevent transmission of HIV to high-risk groups, promote condom use among at-risk populations, and increase demand for high quality CT services.

This is a continuing activity from FY 2009.

Kiziba Refugee Camp is host to approximately 19,000 refugees. Refugee populations are considered to be at high risk of infectious disease, in particular HIV, as well as GBV and other forms of violence, and economic and psychological distress.

In FY 2010, UNHCR through its implementing partner American Humanitarian Association (AHA) will continue to provide PMTCT services in Kiziba Refugee Camp. UNHCR/AHA will provide a PMTCT package of services camps for445 pregnant women, including an estimated 25 HIV-positive women at Kiziba refugee camp. The PMTCT package includes CT with informed consent, including male partners and families; ARV prophylaxis using combination ARV regimes and HAART for eligible women; screening for STIs; infant feeding counseling; implementation of effective PMTCT regimens; prompt CD4 count and clinical staging for HIV-positive pregnant women; safe delivery follow-up; follow-up of infants and mothers; CTX for OI prevention; integration of FP and MCH services; testing and close follow-up of HIV-exposed infants for effective referral to appropriate services and early infant diagnosis; and supporting human resources by providing high-quality training and clinical mentoring.

In addition, UNHCR/AHA will assure an effective continuum of care and mother-infant follow-up by increasing partner involvement and community participation in PMTCT services using peer support groups, community mobilization, community volunteers, home visits, referral slips, community-based registers, patient cards and other monitoring tools to facilitate transfer of information between facilities and communities. To ensure these linkages, social workers will train and supervise community

volunteers and organize monthly health center meetings with staff from all services to follow-up on referrals and other patient-related matters.

In collaboration with TRAC Plus and Project San Francisco, UNCHR, and all clinical partners, will support couples' counseling through training and on-site mentoring to improve pre- and post-test couple counseling quality, improve follow-up mechanisms for discordant couples and women testing negative in ANC to address seroconversion and pediatric infection during pregnancy and breastfeeding

In partnership with WFP, supplemental food will be provided to all pregnant and breastfeeding women, and weaning food to all infants born to HIV-positive mothers (from 6-24 months). Health providers will receive refresher on-the-job training in the expanded national PMTCT protocol and UNHCR/AHA will conduct performance improvement and QA of PMTCT services through regular supervision of sites, coaching and strengthening capacity of sites in M&E.

UNHCR/AHA will support the transportation of EID and CD4 specimen from the refugee camp to the National Reference Laboratory and to health facilities equipped with CD4 count machines for Kiziba refugee camp.

UNHCR/AHA will monitor and evaluate PMTCT activities through ongoing supervision, quality assurance, and data quality controls, and will continue to strengthen the capacity of the refugee health care providers to monitor and evaluate PMTCT activities through ongoing strengthening of routine data collection and data analysis.

PBF is a major component of the Rwandan strategy for ensuring long term sustainability and maximizing performance and quality of services. In coordination with the national PBF program, UNHCR/AHA will continue to support input technical assistance and output performance-based financing (PBF). The basic package of financial and technical support will include technical support, implementation, transportation, communication, training of services and other supports to conduct key responsibilities.

In FY 2008 UNHCR through its implementing partner American Humanitarian Association (AHA), began implementing the national TB/HIV policy and guidelines at Kiziba Refugee Camp.

In FY 2010, UNHCR partner will continue to ensure that 100% of all TB patients are HIV tested, and that

all who qualify receive Co-trimoxazoleand ART. UNHCR partner priority will strengthen the implementation of regular TB screening for all PLWHA, and for those with suspected TB, ensuring adequate diagnosis and complete treatment with DOTS.

With PEFAR funds, UNHCR partner will strengthen the integration of diagnostic services including coordinating specimen and patient transport to referral centers with appropriate diagnostic services (such as chest radiography and diagnostics required for extra pulmonary TB).

In FY 2010, UNHCR will continue to support the Kiziba refugee site for the implementation of the TB/HIV component of the clinical package of HIV care. This activity has seven components: 1) Strengthen routine provider-initiated HIV testing of TB patients at refugee camp sites, continue to report the number and proportion of TB patients who received counseling and testing at supported TB sites. 2) Provide Co-trimoxazoleprophylaxis to all HIV-positive TB patients and ensure referral to HIV care and treatment services. 3) Strengthen regular TB screening, appropriate diagnosis and TB treatment with DOTS. Increase TB screening to PLWHA accessing other HIV services such as VCT/PMTCT, as well as family members of HIV positive patients will be reached through home base care and community programs. 4) Ensure timely and appropriate TB diagnosis and treatment via DOTS for all PLWHA that are TB suspects. 5) Support supervision and monitoring to refugee sites to ensure routine data collection, recording, and reviewing of standard national TB/HIV program indicators aimed at ensuring improved services at the patient and facility level. 6) Support on-going training of doctors, nurses, social workers, and HIV and TB services providers on TB/HIV integration and standard operational protocols using national training modules. 7) Support refugee sites for effective TB and HIV patients' case management and referrals.

These activities reflect the Rwanda National strategic Plan by strengthening the integration of TB/HIV services through the implementation of policies and increased coordination of prevention, counseling, testing, care and treatment services. Lessons learned from integrating TB and HIV reveals the need to strengthen HIV/TB programs in the refugee sites and in neighboring communities.