ICAP is one of the USG partners providing HIV care and treatment services for HIV-positive adults and children in Rwanda. By the end of FY 2009, Columbia was supporting 56 sites in 9 districts to offer high quality HIV care and treatment services. In addition, Columbia supported the Government of Rwanda's effort to integrate services with the aim of maximizing efficiency and effectiveness of HIV services. In this respect, Columbia supported TRAC Plus to introduce the integration of mental health and HIV at Ndera Pneuropsychiatric hospital, and the Maternal and child health unit and TRAC Plus to pilot a tool for the screening of family planning needs. In addition, using its multidisciplinary, quality and family centred approach to the provision of HIV care local while targeting capacitation and sustainability, Columbia supported district teams to own, oversee, supervise and mentor health centers under their jurisdiction. In FY 2010, Columbia will enhance this transfer of skills to UPDC and the district teams, starting with the progressive transfer of responsibility for subagreement management and then program management, monitoring and evaluation and reporting.

Columbia will support 9 DHTs to strengthen their capacity to coordinate an effective network of PMTCT and other HIV/AIDS medical services. Support to DHTs will focus on strengthening the linkages, referral, transport, communications and financing systems necessary to support an effective PMTCT and other HIV/AIDS care network. Columbia will provide financial and technical support to DHTs, including staff positions, transportation, communication, training of providers using the trainers trained by TRAC+, and other support to carry out their key responsibilities. PBF is a major component of the Rwanda exit strategy for ensuring long-term sustainability and maximizing performance and quality of services. In coordination with the HIV PBF project, Columbia has shifted some of its support from input to output financing based on sites' performance in improving key national HIV performance and quality indicators. Full or partially reduced payment of PMTCT 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. In FY 2010 ICAP will continue to assist DHTs to strengthen the M&E system through training service providers and managers in appropriate use of M&E tools as well as use of data for planning and activity monitoring. ICAP will assist the national and district program to improve data collection and reporting on key indicators. In FY 2010, ICAP will transition the management of some of the subagreements as well as the M&E and reporting functions of TRAC clinic to the MOH depatrment UPDC. During this transition, ICAP will provide support to UPDC on financial and project management as well as reporting to UPDC. ICAP will train and mentor relevant UPDC staff on aspects of project management and reporting and gradually withdraw its support as the capacity of UPDC develops. With the support of the 3 technical advisers

seconded to UPDC, ICAP will intensify the training and mentorship of UPDC on the measurement and assessment of the quality of care; gradually leaving this exercise to them.

In FY 2009, Columbia provided basic care services (BCS) to 38,302 and ART to 19,170 PLWHA at 46 sites; which included 4,646 and 4,777 new patients enrolled into care and ART respectively. In FY 2010, ICAP will continue to provide high quality BCS at the 46 existing sites to 38,302 existing patients and an additional 6,070 new patients; and continue to provide high quality ART to the existing 19,170 patients and initiate 3,591 new patients on ART (in accordance with the new generation indicators bringing the cumulative total in care to 44,372 and on ART to 22,761. To ensure comprehensive services across a continuum, ICAP will continue to support the referral of patients enrolled in care to community-based BCS services based on their individual needs.

In FY 2009, Columbia supported TRAC Plus and Ndera Neuropsychiatric Hospital to integrate HIV and mental health services. Under this approach, mental health patients are evaluated for their mental illness as well as HIV/AIDS. Depending on the mental and medical status, an HIV test is proposed and performed either immediately (if the patient is very ill with signs of AIDS) or later (after stabilization) if the medical situation is not worrisome or suggestive of advanced AIDS disease. In FY 2010, ICAP will work with Ndera Neuropsychiatric Hospital, TRAC Plus and the Mental Health unit to scale up mental health and HIV integration services to the other 9 ICAP-supported district hospitals.

In FY 2009, ICAP continued to support high quality pediatric HIV care and treatment services at the two model centers and 44 other sites. A comprehensive package of basic care and support services was provided to 4,688 HIV-positive children and treatment to 2,570. ICAP has been instrumental in initiating family testing as a means to identify HIV-positive children and other adults in the household who would benefit of early care interventions. In FY 2010, ICAP will continue to provide a comprehensive package of care to 4,688 old HIV-positive children and 400 new ones. And provide treatment services for 242 new children to reach a cumulative total of 5,088 of children in care and 2,812 of children on ART by end of FY 2010. To address the need to expand diagnosis of HIV in the pediatric population ICAP will continue to strengthen testing for targeted pediatric populations within the catchment area of its existing sites. Using each HIV adult patient enrolled in care and treatment at ICAP-supported sites, as an index case, ICAP will offer HIV-testing for their partners and children and enrolls the infected family members into care and treatment services.

At PMTCT sites, support groups of HIV-positive women will be strengthened based on the mother-to- mother model and PEARL program approach. Early infant diagnosis services, now available at all ICAP PMTCT supported sites, will be strengthened. EID will continue to be offered at six weeks of age and at any other ages for symptomatic infants less than 18 months post natal according to the national

algorithm. ICAP will continue support to the district health teams to ensure that samples collected at the sites are transferred efficiently to the processing lab at the National Reference Laboratory in Kigali and work with the MOH to increase reliability of result turn-around times.

The prevention of unintended pregnancy amongst HIV-positive women is one of the most cost-effective means of preventing mother to child transmission. In FY 2009, Columbia supported the Maternal and child health unit of the Ministry of Health and TRAC Plus to pilot, at 3 sites in Kigali, a tool for the screening of family planning desires amongst HIV patients. In FY 2010, Columbia will support the MOH institutions in finalizing the review of the tool and scaling up its utilization at national level.

In FY 2009, ICAP supported MOH to develop SGBV guidelines and piloted the initiative at Muhima and Gisenyi District Hospitals. In FY 2010, ICAP will continue to support the Ministry of Health during the national training of trainers on SGBV and roll-out SGBV in HIV programs considering the lessons learned from one year implementation program of the SGBV pilot phase. ICAP will scale-up the initiative at 5 district hospitals and 10 health centers. ICAP will train Peer Educators on SGBV to enable them to sensitize community on prevention of SGBV. In collaboration with the Rwanda National Police, ICAP will support the health facilities to assure that the SGBV victims receive the services on time as recommended in national guidelines.

In the context of the transition plan, ICAP-CU will transition its sub-Agreement with CAAC to MOH. During COP 10, ICAP-CU will continue to actively participate in the PBF extended technical working group, and provide support DHTs and site staff for capacity building through training in use of PBF tools, improvement of site documentation, sites performance evaluation, site data quality assurance to improve key national HIV performance and quality indicators. Full or partially reduced payment of BCS 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. In collaboration with MOH Community Desk and RRP+ ICAP-Cu will continue to support the two local NGOs for capacity building in implanting community PBF through its Peer Education Program (PEARL) to improve key community health indicators.

Under the transition arrangements/planning, CDC will channel funding for some of the ICAP-supported sites to UPDC or another entity to be identified jointly by CDC and GOR, and the PBF funds directly to CAAC. In FY 2010, ICAP will support UPDC to provide technical support and mentorship to the transitioned sites and support develop the capacities of UPDC in financial and programmatic management and reporting. ICAP will continue its support to CAAC in financial management, training of districts staff on PBF as well as the evaluation and verification of bills.

This is a continuing activity.

In FY 2010, ICAP will continue to provide BCS to 38,302 existing patients and add an additional 5,621 new patients at 46 existing sites, as well 10 additional sites which formerly provided only CVT, PMTCT, and OI treatment Services in the BCS package include clinical staging and baseline CD4 count for all patients follow-up CD4 tests, management of OIs, and routine provision of CTX prophylaxis for eligible adults, children and exposed infants based on national guidelines. Patients may also receive basic nutritional counseling and support, positive living and risk reduction counseling, pain and symptom management, and end-of-life care. In addition, ICAP will continue to provide psychosocial counseling including counseling and referrals for HIV-positive female victims of domestic violence. To ensure comprehensive services across a continuum of care, ICAP, through a partnership with peer educators and other community services providers, will refer patients enrolled in care to community-based BCS services based on their individual need. These services include adherence counseling, spiritual support, stigma-reducing activities, OVC support, IGA activities, and HBC services for end-of-life care. In collaboration with the supply chain partner, ICAP will continue to provide diagnostic kits, CD4 tests, and other exams for clinical monitoring, and will work with the supply chain partner to ensure appropriate storage, stock management, and reporting of all OI-related commodities.

Services will emphasize quality of care, continuum of care through effective linkages and referrals, and sustainability of services through technical support to PBF. Strengthened nutritional services through training will include counseling, nutritional assessments using anthropometric indicators, and management of malnutrition through provision of micronutrient and multivitamin supplements, and links to Ibyiringiro food support for clinically eligible PLWHA and children, in line with national nutrition guidelines. ICAP will also support referrals for all PLWHA and their families, particularly children under five and pregnant women, for malaria prevention services, including provision of LLITNs in collaboration with GFATM and PMI; and referral of PLWHA and their families to CBOs and other community-service providers for distribution of water purification kits and health education on hygiene to reduce cases of diarrheal diseases. In addition, family planning education, counseling and methods will be provided to PLWHA and their spouses. This service will be located within the counseling unit of the site to reduce need for referrals. Strengthened psychological and spiritual support services for PLWHA at clinic and community levels will be done through expanded TRAC training in psychological support for all ICAP- supported health facilities and community-based providers, including GBV counseling, positive living, and counseling on prevention with positives.

In FY 2010, Columbia will expand quality clinical services, continue support to the DHTs, increase sustainability through quality assurance and capacity building activities, delegate more management responsibilities to district teams, and strengthen SI at all levels. In order to ensure a continuum of HIV care, ICAP, in collaboration with local organizations such as the Rwanda Network of PLWHA (RRP+), ARBEF and Bamporeze.ICAP will support health facilities in HIV patient follow-up, and organize referrals to care services for HIV patients to minimize lost to follow-up in collaboration with TRACPLUS and MOH. In FY 2010 ICAP will provide direct oversight of community volunteers, including CHWs, PLWHA association members, and other caretakers, and will continue to work with Peer Educators for Adherence, Referral, and Linkages (PEARL), RRP+ and other community based organizations to develop effective referral systems between clinical care providers and psycho-social and livelihood support services. Depending on the needs of individuals and families, health facilities will refer PLWHA to community-based HBC services, adherence counseling, spiritual support through church-based programs, stigma reducing activities, OVC support, IGA activities (particularly for PLWHA female and child-headed households), legal support services, community-based pain management and end-of-life care in line with national palliative care guidelines.

In FY 2009 ICAP served as one of the partners for the OGAC Special Initiative on Sexual and Gender Based Violence, piloting the program at two health facilities. In FY 2010, in collaboration with the Population Council, the national police, and the MCH unit of the MOH, ICAP will extend SGBV services to all ICAP-supported district hospitals, emphasizing the development of health care providers' capacity to treat and manage SGBV clients, as well as the strengthening of SGBV M&E systems.

In FY 2009, ICAP supported the Government of Rwanda's effort to integrate services, with the aim of maximizing efficiency and effectiveness of HIV services. To this end ICAP supported TRAC Plus in the integration of mental health and HIV services in a neuropsychiatric hospital. In this model mental health patients are screened for HIV and those found to be HIV+ are enrolled into HIV care and ART as necessary. After discharge, they are followed up for mental health and HIV care by the same unit. The approach has revealed that it is feasible to provide HIV services to mentally ill patients and that HIV is a significant problem for this population. In FY 2010, ICAP will continue to support the integration of mental health and HIV care at all nine ICAP supported district hospitals. ICAP will support the training of two doctors and four nurses from each district hospital in mental health and HIV service integration, in addition to supporting the finalization and roll out of mental health screening tools at the nine hospitals. ICAP will also support the development of a referral and counter-referral system between the neuropsychiatric hospital and its supported facilities. Finally, ICAP will support mentorship and supervision visits by the neuropsychiatric hospital's staff to the nine district hospitals.

In FY 2009, ICAP supported counseling and testing services at 35 sites including one prison and the neuropsychiatric hospital. In FY06 about 127,000 clients have been counseled and tested. This number was reached using a mix of outreach activities, local authority mobilization and effective referral to the health facilities, linkage within healthcare units and follow-up through a coordinated response between health facilities and the community; in addition to the geographical extension of HCT services including the organization of counseling and testing campaigns and PITC.

During FY 2010, ICAP-CU will continue to support counseling and testing at the existing 35 sites. ICAP will closely work with other partners and GOR to design an efficient model of counseling and testing for couples and an enhanced monitoring and evaluation system for proper tracing and tracking purposes. Through this approach, ICAP will provide counseling and testing services to an estimated 130,000 clients including 1,000 from TB and PITC in all three regions. This activity will be attained through integration of various approaches including community based mobilization for counseling and testing in collaboration with local authorities, an enhanced referral to health facilities and follow up as well as maximization of all entry points with the health care facilities. These include conventional HCT, ANC and general consultation rooms plus nutritional centers and admission wards using PITC and provided in a manner that respects human values, ensures confidentiality , and reduces stigma and discrimination. PICT services will target adult and pediatric patients presenting with HIV-related OIs and TB symptoms,

malnourished children, HIV-exposed infants, STI patients and all admitted patients. A system to ensure coordination between the different counseling and testing units will be utilized to enhance adherence and minimize lost to follow up. During FY 2010, ICAP will support the strengthening of the M&E system (documentation, utilization of tools, data analysis, sharing and reporting) in all services providing PITC.

In order to ensure quality, ICAP will continue to support supportive supervision in frame work of mentorship and standard of care, designing tools and implementation of multi-disciplinary team work at the health facilities to prepare district health teams' capacity for their future problem identification, solving and self-evaluations. ICAP will continue to support counseling and testing indicators embedded in Performance Based Finance (PBF) as a way of improving both quantity and quality of service provision. ICAP will support the quality of data and its utilization for improving the quality of care through regular data quality audits, data analysis training and data sharing workshops and feedback.

In FY 2009, ICAP has been supporting pediatric HIV care at 46 sites in the western province, in Kigali region and in Huye district in Rwanda. Site support included staff training and mentoring on identification of HIV-positive children at various entry points of care, their enrolment in care and treatment program, and long term follow-up. In addition, ICAP site support teams have been providing guidance to sites for the strengthening of their care system: patient flow, delivery of a standardized package of care at follow- up visits, regular multidisciplinary team meetings, appropriate documentation of pediatric care practices, and regular use of a standards of care (SOCs) tool to monitor progress in delivering quality care for children. By September 2009, 4,027 children were enrolled in care including 2,172 children on ART.

FY 2010 starts the first year of transition of TRAC 1.0 partners' activities to the Ministry of Health (MOH): ICAP-CU AIDS will transition 12 HIV care and treatment sites that will be selected based on their demonstrated capacity to provide high quality care for children with minimum support.

ICAP will continue to collaborate with the district to ensure refresher training of health care providers on pediatric HIV care at the 46 supported sites. This will include, among other topics related to pediatric HIV care, the new national pediatric treatment guidelines, identification and management of treatment failure cases, and psychosocial support to children, adolescents and their families. A specific emphasis will be put on early infant diagnosis and the implementation of a reliable and efficient sample transportation system. ICAP will assist heath facilities 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, on treatment or affected by HIV, and to assist with addressing issues around status disclosure and treatment adherence.

ICAP pediatric and clinical advisors will be carrying out monthly site visits for staff mentoring during which support will continue to be provided for the strengthening of the care system and of children support group activities, and for the active tracking of follow-up defaulters. ICAP will also continue to provide support to sites for the appropriate documentation of pediatric HIV care practices, for the use standards of care (SOCs) tools, as well as for regular multidisciplinary meetings to discuss SOCs findings and to address identified challenges.

All these activities will be contributing to the site maturation process that will be monitored through global SOCs scores and an assessment of the capacity health care providers to design interventions to address identified challenges.

In FY 2009, ICAP has been supporting pediatric HIV care at 46 sites in the western province, in Kigali region and in Huye district in Rwanda. Site support included staff training and mentoring on identification HIV-positive children at various entry points of care, their enrolment in care and treatment program, and long term follow-up. In addition, ICAP site-support teams have been providing guidance to sites for the strengthening of their care system: patient flow, delivery of a standardized package of care at follow-up visits, regular multidisciplinary team meetings, appropriate documentation of pediatric care practices, and regular use of a standards of care (SOCs) tool to monitor progress in delivering quality care for children. By September 2009, 4,027 children were enrolled in care, including 2,172 children on ART.

In FY 2010, ICAP will continue to collaborate with the district to ensure refresher training of health care providers on pediatric HIV treatment at the 46 supported sites. This will include, among other topics related to pediatric HIV treatment, the new national pediatric ARV treatment guidelines, identification and management of ART failure cases, and psychosocial support to children, adolescents and their families for ART adherence.

ICAP pediatric and clinical advisors will be carrying out monthly site visits for staff mentoring during which support will continue to be provided for the strengthening of the care system and of children support groups activities, and for the active tracking of follow-up defaulters. ICAP will also be providing support to sites for the appropriate documentation of pediatric HIV treatment practices, for the use standards of care

tools to monitor progress in delivering quality care to children, as well as for regular multidisciplinary meetings to discuss SOCs findings and to address identified challenges.

All these activities will be contributing to the site maturation process that will be monitored through global SOCs scores and an assessment of the capacity of health care providers to design interventions to address identified challenges. FY 2010 starts the first year of transition of TRAC 1.0 partners' activities. ICAP-CU AIDS will transition to the Ministry of Health (MOH) 12 HIV care and treatment sites which will be selected based on their demonstrated capacity to continue implementing high quality care for children with minimum support.

The uptake of PMTCT services in Rwanda is high as indicated by ANC attendance and HIV counseling and testing. However mother and infant follow-up is weak due to high rates of home delivery and infants lost to follow-up. ICAP-CU has provided ongoing site level implementation support to the district hospital multidisciplinary teams to improve uptake and quality of services. The PMTCT package includes: CT, screening for STIs, infant feeding counseling, implementation of PMTCT regimens, prompt CD4 count and clinical staging for HIV-positive pregnant women, combination ARV regimens for non-eligible women and rapid initiation of HAART for eligible women, safe delivery, infants and mother follow-up, CTX for OI prevention, infant HIV testing, and support for human resources by providing high-quality training and clinical mentoring.

ICAP-CU has been successful, particularly with regard to the provision of more efficacious PMTCT regimens, male partner counseling testing and integration of PITC at consultation points, MCH units and hospitalization wards. ICAP-CU has introduced systems to improve CD4 testing uptake in HIV-positive pregnant women which has helped to improve uptake and quality of PMTCT services at ICAP-CU supported sites. ICAP-CU has successfully implemented PMTCT standards of care at all supported sites. In FY 2009, ICAP in collaboration with TRAC Plus and MCH unit within MOH ICAP developed and piloted an FP/HIV screening questionnaire at 3 ICAP-supported sites. Data from the 3 sites revealed the existence of unmet FP needs among HIV-positive patients; and a formal evaluation to assess feasibility and usefulness of the tool will be done later in the year. The results from the evaluation will be used by TRAC Plus and MCH unit to review the screening tool and scale up its utilization in HIV clinics nationwide. ICAP will reinforce its outreach teams and the MOH health animators with training, and transportation in order to track PMTCT clients lost to follow-up and arrange home visits if needed.

In FY 2010, ICAP-CU will provide an expanded package of services to 27,174 pregnant women at 32 existing CT/PMTCT sites. Emphasis will be placed on quality services and continuum of care through operational partnerships, and sustainability of services through PBF, and use of data for mentorship and planning interventions. All (100%) HIV-positive women (1,086) are expected to complete the course of ARV prophylaxis.

ICAP-CU will support PMTCT services providers in HIV care and treatment with emphasis on pediatric care. In addition, ICAP-CU will ensure that all newborns to HIV-positive mothers are put on Co- trimoxazolepreventive therapy until confirmation of their HIV-negative status. ICAP-CU will sustain the PMTCT follow-up system through support to the sites for formal meetings and referrals to ensure that mothers and exposed children are followed up regularly in PMTCT ward but also from vaccination, TB and nutrition wards and to care and treatment ward.

ICAP-CU will strengthen follow-up and tracking systems to ensure testing of family members, routine provision of CTX PT and infant diagnosis, ongoing infant feeding counseling and support in collaboration with the World Food Program and other partners, CD4 monitoring and clinical staging, management of OIs, including TB and other HIV-related illnesses, psychosocial support services at clinic and community levels, identify and refer victims of gender-based violence to appropriate care in collaboration with community care workers, peer educators and other HIV clinical partners, and access to clinical and community prevention, care, and treatment services for family members. ICAP-CU will assure linkage to treatment for eligible women and infant follow-up by 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 RRP+, two local NGOs (Bamporeze and Rwandan Association for the Well-Being of the Family (ARBEF)), health providers and peers educators will refer PMTCT clients and their families to HBC, OVC support, IGA, and facility- and community-based MCH services promoting key preventive interventions such as bednets, immunizations, hygiene/safe drinking water and nutritional support. These community-based services will assist in the monitoring and tracking of pregnant and postpartum HIV-positive women and their infants, as well as promote MCH and PMTCT health-seeking behaviors. In addition social workers will ensure referrals of pediatric patients from PMTCT sites and nutrition centers to ARV services. ICAP-CU will support sites to prepare inventories and projections to requisite ARV drugs, CD4 tests, RPR test kits, PCR, rapid HIV test kits, and hemoglobin testing materials from CAMERWA. ICAP-CU will also collaborate with MSH/RPM+, CAMERWA and SCMS to improve the capacity of DHTS and site providers in drug management, coordinated site-level storage, inventory, tracking and forecasting. In addition, ICAP-CU will collaborate with GFATM, PMI and other community

partners to refer 728 PLWHA and their families for malaria prevention services including bednet provision. In collaboration with CRS, ICAP-CU will provide weaning food for exposed infants, pregnant and lactating women in need. In addition ICAP-CU will continue to leverage food aid from the World Food Program to meet the other nutritional needs of these food insecure households.

In FY 2009, ICAP-CU collaborated with Catholic Relief Service (CRS) which is the principle PEPFAR sub-awardee for the purchase and distribution of nutritional supplements to people infected and affected by HIV and AIDS including weaning food supplements in PMTCT. Under this collaboration, CRS bears the responsibly of purchase and distribution food supplements in the form of fortified weaning food to the mothers of HIV-exposed infants from age of 6 months to 18 months in the first 18 sites. During FY 2010, ICAP-CU will continue this partnership with CRS and EGPAF - the technical assistance provision arm of the program to scale up supplementary and replacement feeding supplements from the current 29 sites to all PMTCT sites. Currently, the program has extended nutritional supplements to include pregnant and lactating mothers. During the primary phase of this extended program, ICAP-CU will closely work with CRS and EGPAF to ensure proper distribution, documentation on site mentorship as well as reporting and feedback mechanisms. ICAP-CU through this partnership ensures proper on-site supplies management (in-good condition storage, enrolment forms, registration books and ration cards), routine assessment to verify dates for expiration and works with the site staff to ensure proper documentation and timely reporting. In collaboration with EGPAF, ICAP-CU will continue to provide IEC materials on infant feeding and family nutrition and other tools for monitoring the feeding of enrolled infants to hospitals and health centers. Building on program data from the current small scale nutritional assessment exercise at a few selected sites, ICAP-CU will perform a basic program evaluation to assess nutritional faltering during weaning phase in PMTCT program.

The overall goal of this activity is to build capacity of the Ministry of Health to support national TB/HIV integration at all levels. TB/HIV capacity building includes development, revision or updating of TB/HIV guidelines for adults and children, creating training materials and job-aids, sharing best practices, improving TB diagnosis, and enhancing supervision, monitoring and evaluation of TB/HIV collaborative activities.

In FY 2009, Columbia University supported the TB and HIV/AIDS/STI (HAS) Units of TRAC-Plus to strengthen TB/HIV program and service integration. Several meetings of the TB/HIV technical working group were organized to assure coordination and joint planning of national TB/HIV collaborative activities.

The TB/HIV national guidelines were revised and updated, M&E system revised and implemented nationwide to accurately capture data on TB/HIV integrated activities. The TB/HIV training curriculum was revised and updated and trainings were organized at district level nationwide. TB/HIV practical trainings were organized for all TB diagnostic and treatment centers nationwide followed by intensive supervision and mentoring to assure quality implementation of HIV testing of TB suspects and patients, CPT for those HIV-positive and prescription of ART if indicated. TB screening for PLWHA was reinforced at USG partner supported sites and a collaborative approach between ICAP and MOH allowed for strengthening of TB screening at the non-USG supported HIV care and treatment clinics. A Public Health Evaluation on best methods to screen HIV-positive children was carried out and preliminary results disseminated. ICAP supported MOH to share TB/HIV best practices at different national and international fora.

In FY 2010, Columbia University will continue to support TB/HIV collaborative activities at central level through a TB/HIV team leader position to coordinate TB/HIV activities between different institutions of the MOH and ICAP. These include providing support to the national TB/HIV working group for revising and updating guidelines, curriculums, and tools, including support for training and dissemination of guidelines at decentralized level. It also includes providing support for supervision of quality TB and HIV service delivery to co-infected patients - particularly to strengthen the implementation of routine HIV counseling and testing especially in TB suspects, prevention education, and referral for HIV care (if needed) for all patients with TB at the TB/DOT clinics. By the end of FY 2010, 90% of all TB suspects will be tested for HIV. Additionally, it includes strengthening of implementation of standardized symptom-based TB screening and intensified TB case-finding for patients living with HIV, with a special focus for the non- USG supported ART clinics. ICAP will continue to support the TB Unit of TRAC-Plus to scale up the TB Infection Control (TB IC) Program through revision of guidelines, tools and job aids. By the end of FY 2010, all District Hospitals in Rwanda will have a TB IC Plan, implementing at least the minimum package of TB IC activities.

Through collaboration with TRAC-Plus and UPDC, ICAP will strengthen mentorship and supervision capacity at central and district level to improve quality of TB diagnosis in TB suspects. This approach is based on TB/HIV standards of care evaluation, district evaluation meetings and supportive supervision and mentorship. In FY 2010, training will be organized for 10 DHT. These trainings will jointly address TB/HIV and the pediatric HIV quality improvement programs.