IRC's international programs have three main aims that are articulated in its Program Framework. Saving Lives: IRC works with persons affected by conflict to sustain their survival with dignity and safety, this refers not only to preventing mortality, but also to ensuring people's basic rights. Strengthening Institutions: IRC supports transparent, inclusive, accountable and participatory institutions that are the foundation for a well-functioning society. Promoting Social Cohesion: IRC strives to enhance the mutual bonds of social cohesion that promote tolerance, pluralism and inclusion in communities.

IRC's programming is guided by key principles that are outlined in the following ways. Protecting and Promoting Rights as entitled by international law, participation of community members and government authorities among the populations IRC serve, capacity building in order to empower individuals, communities and organizations with the tools to identify and act upon their priorities, having partnership with beneficiaries and other stakeholders to ensure ownership and by holistic programming whereby IRC incorporates into its planning the different variables that exist in a setting and integrates multiple sectors in any given setting.

IRC provides health services, serving sixty eight thousand four hundered and sixteen people the in four refugee camps of Mtendeli, Kanembwa, Nduta and Mkugwa. Basic health services in each camp include inpatient and outpatient care for common diseases as well as reproductive health care and community health promotion. HIV services, in addition to VCT are provision of anti-retroviral prophylaxis to prevent mother-to-child transmission of HIV, post exposure prophylaxis for survivors of sexual violence, co-trimoxazole prophylaxis for all HIV positive persons and home based care and support.

IRC's HIV Programs aim towards three primary objectives. Contributing to the documentation and monitoring of the scale and characteristics of the HIV epidemic; preventing and reducing HIV-related morbidity and mortality and contributing to the development of best practices through a program of collaborative operations research and dissemination of lessons learned.

IRC has been running the PMTCT program in the four Kibondo camps since 2003. In order to reduce the incidence of HIV transmission in Kibondo District, amongst other issues, it is necessary to strengthen the PMTCT services available within these refugee camps.

The activities that have been implemented under PMTCT this year include community sensitization, counseling and testing (CT), and provision of antiretroviral prophlexis to positive mothers and their newborns. From January to June this year, 1,565 women made their first antenatal visit for a current pregnancy and all of them accepted to be tested for HIV as did 1,120 of their spouses (71.6%). Of the mothers in ANC who took part in CT and were found to be HIV positive (a total of twelve), 100% opted to participate in the PMTCT program. Twenty five HIV positive mothers enrolled in the PMTCT program from April to September 2005 delivered during the first six months of this year; all were normal spontaneous vertex deliveries. All twenty five mothers and their babies received nevirapine as per protocol.An average HIV prevalence of 1.9% was found among the antenatal mothers during the first six months of 2006.

The three goals for this PEPFAR-funded project will be: continue to have four sites providing PMTCT services, one in each of the camps, 3,500 women (total from all camps) receiving CT services through the PMTCT program over the course of the year. This target is based on the average number first visits at antenatal clinic, and fifty women estimated to receive ARV for PMTCT, based on the seroprevelence rate amongst pregnant mothers from our statistics.

Four service outlet sites providing the minimum package of PMTCT services according to national standards at each of the four MCH clinics, one per camp. These four sites will be having a CT site specifically targeting the pregnant women and their spouses under the PMTCT Program.

Through this PEPFAR-funded project IRC will maintain eight PMTCT-specific HIV counselors and will provide refresher training to updrade their counseling capacity.

IRC also will strengthen community outreach activities to raise awareness of HIV

transmission and the availablity of PMTCT services for reducing vertical transmission of HIV from mothers to their babies. In these campaigns male involvement will be emphasized so as to fight stigma and enhance partner support for testing and in caring for the newborn babies delivered by HIV positive mothers.

Through this program, IRC will improve other supplies for the PMTCT program including procurement of ARVs (Nevirapine tablets for HIV+ mothers and syrup for newborn babies of these mothers), syringes, safety boxes, sterile gloves, antiseptics and other essential supplies.

IRC will also improve the supply of the drugs for opportunistic infections, which will also benefit HIV positive mothers and their newborn babies. These will also include prophylactic drugs (Cotrimoxazole and INH) for potential opportunistic infections.

IRC will maintain the same number of CT sites one for each of the four camps, at each MCH Clinic for the PMTCT program.

UNICEF supplies rapid CT testing kits for the PMTCT program however, sometimes due to unreliable supplies for all CT sites, the needs grossly outnumber the supplies, thus leading to stock outs. With this funding, IRC will ensure constant supply of rapid test kits for HVCT under the PMTCT program.

IRC recognizes the need to design, monitor and evaluate its HIV programs in a way that is consistent with international and national guidelines. The monitoring and evaluation will follow its internal monitoring system which is consistent with PEPFAR requirements and will provide reports according to the schedule agreed in the donor contract. IRC will maintain monitoring and evaluation staff in each facility in the four camps.

The International Rescue Committee is a US-based organization. In Tanzania, IRC provides comprehensive health services in refugee camps in Kibondo. IRC's programming is guided by key principles that are outlined in the following ways: protecting and promoting rights as entitled by international law; participation of community members and government authorities among the populations we serve; capacity building in order to empower individuals, communities, and organizations with the tools to identify and act upon their priorities; having partnerships with beneficiaries and other stakeholders to ensure ownership; and by holistic programming whereby IRC incorporates into its planning the different variables that exist in a setting and integrating multiple sectors in any given setting.

IRC serves sixty eight thousand four hundered and sixteen people the in four refugee camps of Mtendeli, Kanembwa, Nduta and Mkugwa. Basic health services in each camp include inpatient and outpatient care for common diseases as well as reproductive health care and community health promotion. HIV services, in addition to VCT, are provision of anti-retroviral drugs to prevent mother-to-child transmission of HIV, post exposure prophylaxis for survivors of sexual violence, co-trimoxazole prophylaxis for all HIV positive persons and home based care and support.

The goals for this PEPFAR-funded VCT project will be to continue providing VCT through eight VCT sites, two (including the PMTCT specific one) at the health facility and one at the youth centre in each camp reaching 10,000 persons (total from all camps). This is based on the current attendance plus meeting additional demand anticipated. Twelve HIV counselors will be trained to supplement the current number of counselors available.

In first six months of 2006, the VCT clinics attended to 3,712 beneficiaries (3,188 refugees and 524 Tanzanian nationals). All received pre-test counseling, were tested, returned for their results, and received post-test counseling. Of the refugees tested, 85 (2.7%) were found positive for HIV.

Although VCT services are available at the health facilities as well as at youth centers in the camps, the access to VCT rapid tests has been a constant challenge to IRC since the inception of the service due to budgetary constraints and limited availability of supplies via UNHCR funding. Currently VCT testing kits are supplied through funding from UNHCR with supplementary funding from PRM. However, the needs grossly outnumber the supplies, thus leading to frequent stock outs and un-served clients. With PEPFAR funding, IRC will ensure constant supply of rapid test kits for VCT sites, in addition to needles, syringes, gloves, sharps disposal boxes.

Tanzania hosts thousands of refugees who fled ethnic violence and other conflicts in the Great Lakes Region of Central Africa. The International Rescue Committee (IRC) has been serving this refugee population in western Tanzania since December 1993. IRC has provided comprehensive health and nutrition services in Mtendeli and Nduta camps since 1996 and in Kanembwa camp since 2004. At the end of March 2007, total camp population in the Kibondo District camps was 55,560. In FY 06 and FY 07 IRC received PEPFAR funds to provide a full complement of preventive HIV/AIDS services under the PMTCT and VCT programs. The PMTCT program includes community sensitization, laboratory services, PMTCT for women and HIV testing for their partners, labor and delivery and provision of nevirapine to HIV positive mothers and their newborns. In 2006 IRC tested 2,835 refugee women through the PMTCT program, and 2,099 refugee partners. In the first six months of FY 07 in the four refugee camps IRC tested 2109 women and gave out nevirapine to 31 HIV positive mothers and their newborns. IRC also provides VCT services to the general population in the camps through 4 VCT centers and 4 youth centers. For the six months of FY 07 IRC provided VCT services to a total of 3709 people (2294 males and 1415 females). In addition, IRC supports and facilitates PLHWA peer support groups in each camp. These peer groups have been meeting but none of the members are currently able to received care and treatment services. IRC Tanzania have long realized that a major gap in our health care services provision is the failure to provide life-prolonging antiretroviral (ARV) medicines to the HIV positive refugees in the camps of Kibondo District. This gap has become more pronounced recently as the Kibondo District Hospital (KDH) has begun an ARV program for Tanzanian nationals. Since 2003, approximately 800 people (approximately 27% Tanzanian national, 73% refugee) have tested positive for HIV in the camps of Kibondo District through the IRC VCT/PMTCT services. It is estimated that 20% of the HIV positive refugees in the camps of Kibondo District would be eligible for ARVs. Because some of the people that have tested positive since 2003 may have repatriated or died, IRC estimates that there are between 100-200 patients in Mtendeli, Nduta, and Kanembwa camps that are eligible for therapy but are not being treated for their advanced HIV disease through our services. IRC also believes that with the knowledge of the availability of treatment more clients will come forward in VCT settings to learn their HIV status. Therefore IRC, in collaboration KDH and Columbia University (the ART treatment partner in Kigoma) aims to spearhead the initiation of ARV provision to the refugees of Kibondo District. KDH would be the primary service provider for ARV therapy through a referral system, but IRC staff would conduct staging and follow-up visits in conjunction with KDH staff. Due to the long distances between the camps and the Kibondo District Hospital between 30 - 70 km, and the fact that refugees are not permitted to leave the camps nor have the funds to access public transport this proposal would provide the care in the camps through collaboration with KDH. IRC will work with the district, regional, national health authorities to conduct trainings of staff and coordinate referral of patients to KDH. IRC will need to conduct an initial training of IRC health care staff on HIV/AIDS staging and basic HIV clinical management including opportunistic infection management and ARV medication side effects. This training will be conducted by the NACP district, regional and national HIV training facilitators. The District HIV Coordinator will then conduct screening consultations for the purpose of staging the HIV positive patients, which will be done in collaboration with refugee clinical staff. Those patients who stage in for therapy will then need adherence counseling and education conducted by district, regional or national HIV training facilitators. After this is complete, IRC staff will need to be trained in home based care principles for HIV patients on ARV therapy. Finally, ARV therapy can then be initiated by the District HIV Coordinator. There are currently about 10 ARV treatment sites in Burundi that are all run by the government. They provide a full complement of first and second line ARV medicines, including the same regimens that are offered through the Tanzanian national program, as well as opportunistic infections medications. IRC will direct repatriating refugees that are HIV positive to areas in Burundi that have a full complement of HIV services and this would be particularly vital for patients on ARVs. Through KDH, IRC will work to provide these patients with three months of medications upon departure for repatriation which is currently the standard for other chronic medications. Medications will be provided by KDH, where they currently have available first and second line therapy in accordance with Tanzanian national guidelines. The District HIV Coordinator will conduct follow-up visits with patients started on ARV medications once

per month. Patients that present with urgent medical situations in the intervening period between these scheduled follow-up visits will be cared for in IRC outpatient departments and complex cases will be referred and transferred (at IRC cost) to KDH for further treatment. IRC would pilot this program with the refugees at Kanembwa camp first and then at Nduta camp in subsequent months. Refresher trainings of IRC staff should be conducted every 6 months to ensure high quality of care. This is a time limited activity, as the Care and Treatment of refugees would only be until they are repatriated and prior to that IRC would work to connect them with existing care and treatment services in Burundi. IRC has been in communication with several partners providing health care and other services to repatriating refugees in Burundi. IRC Tanzania is committed to providing high quality health care to the refugees of Kibondo District. The inability to provide life-saving ARV medications to HIV positive patients is currently the most important gap in their health care program. Each month several preventable deaths occur in each of the four camps due to complications with HIV AIDS. Through an ARV therapy referral program implemented with KDH , IRC can now save lives and improve the quality of lives of many others. In addition, the training and experience that IRC staff (both Tanzanian national and refugee) will gain through this program will provide them with valuable skills that will serve Tanzanian and refugee health programs in general.