KIZIBA Refugee Camp: According to the most recent UNHCR statistics hosts 18,952 refugees from North and South Kivu, and eastern DRC. HIV transmission among Congolese refugees depends upon numerous competing and interacting factors. Some of the factors specific to the Congolese refugees residing in Rwanda include: a relatively high amount of cross-border traffic amongst refugees due to geographic ease; the length of stay of refugees in Rwanda, with some camps being open for more than 15 years; and no sign of the conflict abating in DRC. KIZIBA camp is located in the highest HIV prevalence district (Karongi) in Rwanda.

UNHCR works through African Humanitarian Action (AHA) in order to implement HIV/AIDS activities in the Kiziba refugee camp. AHA has been implementing HIV program interventions in the camp with PEPFAR funding since 2007. There has been a steady increase in the number of people arriving for HIV testing, inclusive of couples testing during antenatal care. At the same time, HIV prevention and awareness messages targeting youth, boys and girls, men and women, and religious leaders have been disseminated in the community, and treatment for adults and children has been expanded benefiting both refugees and locals. AHA focuses its attention on 10 programmatic areas: PMTCT, community awareness on condom promotion, HIV care and support for adults and children, palliative and integrated TB/HIV care, HTC, treatment for adults and children, and coordination, monitoring, and evaluation mechanisms.

No vehicles have been purchased or leased or planned under this mechanism.

The goal is to provide HIV care and support to adults in Rwankuba Sector and Kiziba Refugee Camp.The funding for this activity will support the provision and expansion of palliative care and clinical services, as well as the training of health providers, laboratory technicians, PLHIV, Home-Based Care Providers and community volunteers. AHA will ensure the provision of in-patient and out-patient clinical services, including diagnosis and treatment of OIs and other HIV-related illnesses (including TB), routine clinical staging, systematic CD4 testing to follow progression of HIV and earliest determination of ART eligibility, and routine recording and reporting of programmatic data. In addition, AHA will provide palliative care services including routine psychosocial support, home visits, identification and training of Home-based Care Providers, PLHIV Associations, and routine trainings for PLHIV and HBCPs that include information on nutrition, positive living, ARV adherence and self-care

The goal is to provide palliative care and TB/HIV-related services to patients in Kiziba Refugee Camp and Rwankuba Sector. In COP12, the objectives are: to ensure that all TB patients are tested for HIV; all HIV infected patients are screened for TB; all patients identified with active TB receive quality and complete TB treatment; all TB/HIV co-infected patients receive ART per national guidelines; and appropriate referral is ensured for all cases of multi-drug resistant TB. AHA in collaboration with Kibuye Hospital will continue to build the capacity of national health staff by providing refresher trainings on TB and TB/HIV.

The goal is to ensure pediatric care and support to children in need in Kiziba Refugee Camp and Rwankuba Sector. The funding for this activity will support the provision of early infant diagnosis, Co-trimoxazole for HIV-exposed infants per national guidelines; and ongoing clinical monitoring and staging for ART initiation. In partnership with WFP, AHA will provide supplemental food to all PLHIV in the camps regardless of their ART status, and AHA will also provide supplemental milk to all infants born to HIV-positive mothers (from 6-24 months).

AHA will reach more refugees with counseling and testing by strengthening PIT for patients at the consultation level, as well as all TB and STI patients, malnourished and non-thriving infants, and patients presenting with HIV-related illnesses. Ongoing community-based campaigns will utilize refugee groups, refugee community leaders, and PLHIV to communicate HIV/AIDS stigma reduction messages and promote CT. Health providers will receive training and refresher training on PIT, as well as in counseling for youth, male partners, and other targeted populations in refugee camp settings. Counseling will emphasize partner reduction, stigma, and alcohol reduction to sensitize clients to issues related to GBV, as well as confront social norms that contribute to these issues.

The goal is to promote correct use of condom and other prevention methods to reduce new infection among refugees in Kiziba Refugee Camp and Rwankuba Sector. AHA will program for Prevention with Positives (PwP), targeting HIV-positive refugee patients, including discordant and married HIV-positive couples; unmarried HIV-positive refugee men and women; and ART patients. Community Health Workers (CHW) and health providers will target condom messages to high-risk populations in the camps-at-large, as well as routine sensitization in the health center. Condoms are made available at different spots in the camp. CHW are involved in this activity.

The goal is provision of PMTCT services at Kiziba Refugee Camp and Rwankuba Sector. AHA will offer a standard package of PMTCT services that includes counseling and testing of pregnant women, male partner testing, family testing, ARV prophylaxis using combination ARV regimes and HAART for eligible women, close follow-up of HIV-exposed infants for effective referral to appropriate services including early infant diagnosis, where possible. In addition, during the 2011-2012 funding cycle, AHA will try to scale-up integration of FP services within the PMTCT setting, ensuring that women and their partners receive the necessary information to make informed decisions in regards to family size, child spacing and available contraception methods.

The on-site package of services includes support to ARV-specific staff to follow all PLHIV from the time of diagnosis and ensure that they receive proper clinical and nutritional counseling and care. It also includes treatment with ARVs according to the national guidelines, follow-up clinical monitoring of CD4 count every six months, viral load counts for patients with decreased or stable CD4 after nine months of HAART, management of ARV drug side effects, ongoing adherence counseling, nutritional counseling, and patient referral to palliative care services. In partnership with WFP, AHA supports supplemental food to all PLHIV on ART. AHA also supports nationally certified training for health care workers in the camps in provision of ART, adherence counseling, ongoing clinical monitoring; management of ART related side effects, and referrals.

The on-site package of services includes support to ARV-specific staff to follow HIV-positive infants and children from the time of diagnosis to ensure they receive proper clinical and nutritional counseling and care. It also includes treatment with ARVs according to the national guidelines, follow-up clinical monitoring, and CD4 count every six months, viral load counts for patients with decreased or stable CD4 after nine months of HAART, management of ARV drug side effects, ongoing adherence counseling, nutritional counseling, and patient referral to palliative care services. Nationally certified trainings are offered for health care workers in the camps clinic in the provision of ART for children, adherence counseling, ongoing clinical monitoring; management of ART related side effects, and referrals.