Following the recent MOH restructuring and creation of the Rwanda Biomedical Center (RBC), TRACPlus has been merged into the Institute of HIV/AIDS and Disease Prevention and Control (IHDPC), an institution within the RBC. The former TRACPlus received PEPFAR support for activities that are now within the HIV, TB, and Epidemic Infectious Diseases Divisions under RBC/IHDPC. The mission of RBC/IHDPC/HIV Division is to provide evidence-based, technical leadership for the prevention and control of HIV & AIDS, through independent applied research, multi-stakeholder participation, and for improved quality of services and strengthened health systems. In addition, RBC/IHDPC ensures quality of services for HIV/AIDS, STIs and blood-borne diseases at health facilities through trainings, formative supervision, clinical mentorship, and data reliability and validity assessments. The overall goal of this project is to improve national surveillance capacity and the planning, implementation and evaluation of HIV/AIDS prevention, care and treatment programs. RBC/IHDPC is also in charge of developing, updating, printing and distributing guidelines and protocols, strengthening the community DOTS approach, MDR TB suspect identification and improving sample transportation. RBC/IHDPC has the mandate to improve integrated disease surveillance and to conduct capacity building activities for health care providers, including activities through the Field Epidemiology and Laboratory Training Program. Following national regulations, RBC contracts a company that provides vehicles for field work. Request for those vehicles are made on an as needed basis. Two trucks for the transportation of mobile X-ray machines were purchased in 2011 for the TB prevalence study. No vehicles are planned for purchase.

RBC/IHDPC will implement prevention with positives (PwP) activities and integrate them into national care and treatment programs. The activities will reinforce programs started in COP2009, by assuring training of physicians and community counselors who will be providing prevention counseling for HIV positives. The activities will also reinforce the Five Prevention Steps for HIV Infected individuals. In addition, they will assure training to incorporate Prevention with Positives interventions as a standard of care in ART sites. This will help ensure that people living with HIV benefit from tailored interventions to reduce transmission rates to HIV uninfected populations. Clinical and Lay Community Counselors will promote couples counseling and testing and also provide PwP messages to all their clients.

In COP13, RBC/IHDPC HIV division will work with MOH to scale up mental health and HIV services Integration.

RBC/IHDPC . RBC/IHDPC will coordinate revisions and updates, and will ensure printing and national distribution of OI and STI guidelines as needed. The HIV division in collaboration with other stakeholders will provide timely and accurate data to the Coordinated Procurement and Distribution System (CPDS) on OI and STI drug and diagnostics supply consumption, as well as OI and STI-related morbidity and mortality. Lastly, RBC will support activities related to food by prescription for PLHIV presenting with moderate or severe malnutrition.

In COP12, RBC/IHDPC/TB division will strengthen the TB/HIV monitoring and evaluation system by revising M&E tools based on WHO recommendations and by improving data analysis and its utilization for decision making. PEPFAR will continue supporting the TB Division within RBC for the development of training guidelines and tools to increase the capacity for extrapulmonary TB (EPTB) diagnosis.

The TB Division will continue scaling up provision of Isoniazid Preventive Therapy in People living with HIV. TB infection control policy in health facilities will also be extended through development of infection control plans, supervision, and monitoring & evaluation. COP12 funding will continue to support the MDR and X-DR TB surveillance and laboratory networking for sample transportation and ensure that MDR TB patients adhere to their treatment regimens.

In order to improve TB detection and adherence to TB treatment, TB Division will strengthen community DOTS approach by supervising the community health workers. One evaluation is proposed to be conducted through this grant: the Evaluation of the implementation process and preliminary impact of Isoniazid preventive therapy (IPT) program in adult PLHIV in Rwanda.

In COP11, in collaboration with implementing partners and district hospitals, through mentorship and trainings, the IHDPC/HIV Division has been scaling up psychosocial care and support services for children and adolescents. These services include HIV diagnosis disclosure counseling, pediatric support groups and ongoing individual psychosocial consultations in more than 187 ART health facilities. Guidelines, tools and job aids will be revised for care and support of children infected by HIV.

In COP12, with TA from PEPFAR implementing partners, IHDPC/HIV Division will focus on care and support of HIV-positive adolescents including mental health, adherence, sexual and reproductive health and psychosocial support. A model of care of HIV-infected adolescents will be developed and extended in several health facilities. The psychosocial care for children and adolescents will be reinforced with specific focus on problems surrounding adherence and disclosure. The development of needed tools (nutritional, mental health screening, adherence measurements tools, and reproductive health job aids) will be supported. The diagnosis and treatment of OIs in children will be reinforced through integrated trainings and mentorship. Nutrition formative supervisions and trainings will be conducted for nutrition evaluation and care of children with moderate and severe malnutrition. To ensure quality of care, providers will be trained in the provision of comprehensive care and treatment services to HIV-infected adolescents and early infant diagnosis and treatment guidelines for HIV-exposed children will be reinforced. The care and support of children and adolescents will be integrated in both mentorship and monitoring and evaluation systems to ensure the follow up and retention in care.

RBC/IHDPC interventions within the Strategic Information area cover the three major areas: surveys and surveillance; HMIS; and Monitoring and Evaluation. RBC/IHDPC will conduct HIV surveillance using PMTCT data, female sex workers, HIV drug resistance (HIVDR) early warning indicators abstracting, indicators of HIVDR from patient files, HIVDR Threshold Survey exploring transmitted HIVDR and HIV Monitoring exploring HIVDR acquired after 12 months of ART initiation in sentinel sites. Integrated Disease Surveillance and Response will be strengthened at all level (central, district, health centers and community). At the same time; RBC/IHDPC will continue to ensure TRACnet system and electronic Integrated Disease Surveillance and Response (eIDSR) module administration by carrying out routine system administration tasks, providing end-users helpdesk and technical assistance in line with the system operations. RBC/IHDPC will also implement activities related to Open MRS. To support ICT infrastructure, the ICT equipment, network, centralized power systems and software at RBC/IHDPC licensed tools will be acquired, applied & maintained.

The focus of M&E activities in COP12 will be on the improvement of data quality, planning, reporting, and utilization of data for program management & service delivery. The M&E Unit will conduct data analysis and improve use as it relates to clinical prevention, care, treatment, to monitor the quality of services provided. As far as HMIS is concerned, RBC/IHDPC efforts will focus on maintenance, upgrade and implementation of the TRACnet system.

RBC/IHDPC/HIV Division will continue to emphasize improving data quality reported into the TRACnet system through decentralized trainings of district supervisors, data managers and M&E officers. Feedback mechanisms will be enhanced. TRACnet data quality audits and integrated supervisions will be continued and quarterly dissemination meetings will held on achievements to monitor TRACnet reporting completeness and timeliness.

Through USG support, the Rwanda Biomedical Center (RBC, formerly TRAC Plus) is implementing activities around human resources and information systems, two of the essential building blocks of the Health System Strengthening. During FY2014, RBC will be training 160 health care workers to support the smooth implementation of the Rwanda HIV/AIDS program through an integrated training protocol that covers prevention, care, treatment and social mitigation program areas. Guidelines and training materials will continue to be developed to support these activities. RBC in collaboration with the School of Public Health will be supporting the implementation of Rwanda public health leadership capacity building and improved epidemiological and laboratory skills to better the HIV/AIDS program and other health programs

The biomedical prevention program within the Prevention department has the objective of scaling-up activities related to male circumcision (MC) and prevention with positives (PwP). These activities entail a comprehensive prevention strategy including: development of programs to assist PLHIV to take measures to avoid exposing other people to infection and provision of male circumcision comprehensive services. In COP12, activities include provision of supervisory and technical support to districts and health care facilities in the provision of services for male circumcision and PwP.

In COP12, Biomedical prevention desk in collaboration with other USG partners such as Drew University, will continue to support MC activities in military health facilities, police and in their catchment areas while ensuring availability and use of reusable male circumcision kits, supplies and equipment to facilitate provision of services and enable the scaling up of services in the health facilities. Renovation of existing health facilities infrastructure will also be continued in line with PEPFAR and HHS/CDC guidance to ensure quality of HIV services.

RBC/IHDPC has developed a minimum package of male circumcision services and will continue M&E of the circumcision program.

In COP12, the VCT program through USG funding will continue to support existing VCT sites nationwide. It will also continue to support PITC (provider initiated counseling and testing) implementation in existing USG sites. In COP12, HIV testing using finger prick method (rather than venous blood draw) will be rolled out and the HIV division will conduct trainings and mentorship for implementation. Quality assurance (QA) and quality control (QC) for tests conducted using finger prick method will be undertaken in conjunction with the National Reference Laboratory.

The VCT desk within the RBC/IHDPC HIV division will organize decentralized training and mentorship on the follow-up package for discordant couples and will conduct M&E activities to document HIV incidence. It will also continue to support outreach VCT (HTC) for key populations with emphasis on mobile populations (truck transporters, men in uniform, commercial female sex workers, MSM) and people with disabilities. The VCT program in collaboration with the care and treatment program will support sites to strengthen linkages between VCT services and pre- ART services.

RBC/IHDPC/HIV Division will continue to update national HTC norms and tools (e.g. client forms, reporting forms, registers, educational and supervision tools) and will disseminate them to all health facilities providing CT services. Ongoing revisions are necessary in order to address new approaches to HTC and PITC, couples testing and discordant couple follow-up as new strategies of the national HTC program.

Rwanda and its partners are committed to achieving elimination of mother to child transmission by 2015. In COP12, the HIV division will continue to provide support to existing PMTCT sites through decentralized trainings and mentorship and supervision of all districts to maintain high quality of services. To ensure continuum of care and the family-centered approach in the PMTCT program, the HIV division will provide training for PMTCT standalone sites to provide HIV clinical services to other family members. The HIV division will reinforce mentorship and supervision of PMTCT standalone sites, provide training on task shifting, and support capacity for EID testing, including improved sample transportation. To maintain and improve the quality of PMTCT services, the HIV division will revise and update national guidelines, continue to conduct refresher training of trainers and supervisors (TOT and TOS) and support training of providers at the decentralized level on the expanded PMTCT protocol. In addition, nutrition support will be given to HIV exposed infants according to revised protocols as well as to HIV exposed infants in categories 1, 2 and 3 of the household income classification. In COP12, the HIV division will continue to reinforce the M&E system for the PMTCT program and ensure continuous availability of reporting tools and job aids.

In COP12, the HIV division in RBC/IHDPC will continue supporting HIV care and treatment sites to provide ART services according to national and international evidence-based guidelines, including immunological and virological laboratory monitoring and management of ART complications and treatment failure.

The HIV division in collaboration with the National Reference Laboratory (NRL) will provide mentorship to improve detection and management of treatment failure. The HIV division will provide training to clinicians to identify patients in need of VL testing, and will work to improve viral load capacity at sites through improved sample transportation, and coordinate with NRL for timely results.

The HIV division in RBC/IHDPC will also reinforce active surveillance of HIV drug side-effects and set up a national register for ARV side-effects. In addition, in collaboration with MOH/Decentralization and Integration Unit, the HIV division will conduct country-wide periodic evaluations of treatment outcomes of ART patients to identify factors influencing failure of ART and will implement strategies to reduce the number of patients lost to follow-up in entry points and in ART programs. RBC/IHDPC HIV division will continue to support task shifting and mentorship activities.

RBC/IHDPC will lead the process of developing cost effective treatment guidelines and tools according to priority areas. It will also be responsible for printing and dissemination of updated guidelines, tools, and job aids related to HIV treatment.

The main goals of the Pediatric HIV treatment program are to increase the number of pediatric patients on ART and to improve the quality of pediatric care at all sites. In COP12, RBC/IHDPC will emphasize: quality improvement in pediatric care and treatment at ART sites and early diagnosis and treatment in children according to existing national guidelines. RBC/IHDPC will also seek to increase coverage for pediatric patients enrolled in the treatment program, reduce the number of patients lost to follow-up at any entry point, and in collaboration with other PEPFAR implementing partners, improve the management of long-term ART-related complications including metabolic complications.

RBC/IHDPC will continue to support: age appropriate approaches to care and treatment of children living with HIV including a program for HIV infected adolescents; the development, dissemination and implementation of monitoring and evaluation tools, including registers, supervision tools and check lists according to national guidelines; the implementation of a harmonized mentorship program to improve the quality of pediatric HIV care, treatment and support at the district hospital level; the development, printing and dissemination of new or updated HIV and OI guidelines and tools according to needs; and the implementation of cost effective trainings, workshops, and conferences in priority areas.

To expand the capacity to provide ART services at the national level the RBC/IHDPC/HIV Division, in collaboration with the MOH/Decentralization and Integration Unit, will support pediatric task shifting from central level to district hospitals and from district hospitals to health centers.