This activity relates to activities in HTXS (7190), HVCT (8165), HBHC (7191), HVOP (8135), MTCT (7181, 7208, 7202, 7219, 7244), HVOP (8133), HTXD (8170, 7214) ; HVSI (7237), HKID (8150), HLAB (7192), HVAB (7230), HBTB (8146).

In the RDF health network there are three military hospitals and five brigade clinics throughout the country. Drew University began working in two military hospitals and three brigade clinics in FY 2005 with EP support. The support modalities include TA and training on ARV and palliative care, M&E, and laboratory infrastructure. Drew collaborates with CHAMP for services in military communities such as OVC support, and receives drug procurement from PFSCM. In line with national policies, the hospitals incorporate performance-based financing as incentives for facilities.

In FY 2007, Drew University will work with the RDF and TRAC to increase access to PMTCT services in RDF settings. PMTCT services will be integrated into existing infrastructure in military HIV/AIDS service delivery sites. Drew University will provide financial and technical assistance for PMTCT services in three military hospital sites. Drew will offer a standard package of PMTCT services to 2,599 pregnant women which includes CT with informed consent, male partner and family-centered testing, IPTp in collaboration with PMI, ARV prophylaxis using combination ARV regimens and HAART for eligible women, identify and refer women who may be victims of gender-based violence to appropriate care in collaboration with Twubakane, IF counseling and support, referral for FP and MCH services, and close follow-up of HIV-exposed infants for effective referral to appropriate services, and early infant diagnosis, where possible. In addition, Drew will ensure access to a comprehensive network of services for PMTCT clients and their families, link PMTCT services with other HIV and MCH interventions, and assure an effective continuum of care by increasing patient involvement and community participation in PMTCT services.

Through the DMS and a combination of input TA and output performance based financing, Drew University will ensure access to a comprehensive network of services for PMTCT clients and their families, link PMTCT services with other HIV and MCH interventions, and assure an effective continuum of care by increasing patient involvement and community participation in PMTCT services.

Drew University will train RDF providers and second technical staff at three military hospitals of Kanombe, Kaduha and Ngarama with new and refresher on-the-job training in the expanded national PMTCT protocol, including use of site-level algorithms and checklists, as well as for laboratory monitoring. In collaboration with DMS, Drew University will conduct performance improvement and QA of PMTCT services through regular supervision of sites, coaching, and strengthening capacity of sites in M&E of PMTCT. Drew University will support DMS build their QA and M&E skills, including in data collection, data use, and reporting.

In collaboration with CHAMP, GFATM, PMI and case managers, providers 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 which will intensify case finding and improve adherence to the new regimen. In addition these case managers will ensure referrals of pediatric patients from PMTCT sites and nutrition centers to ARV services.

PBF is a major component of the Rwanda EP strategy for ensuring long-term sustainability and maximizing performance and quality of services. In coordination with the HIV PBF project, Drew will shift 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.

Through the PFSCM, Drew will provide ARV drugs, CD4 tests, RPR test kits, PCR, rapid HIV test kits, and hemoglobin testing materials to all supported sites. Drew will also

collaborate with RPM+ to improve the capacity of providers in drug management, coordinated site-level storage, inventory, tracking and forecasting. In addition, Drew will collaborate with CHAMP, GFATM and PMI to refer 728 PLWHA and their families for malaria prevention services including bednet provision. In collaboration with CRS, Drew will provide weaning food for exposed infants in need. In addition Drew will leverage food aid from Title II and the World Food Program to meet the other nutritional needs of these food insecure households.

This activity supports the EP five-year strategy for national scale-up and sustainability and the Rwandan Government decentralization plan.

test

Table 3.3.01:

This activity relates to HTXS (7190), HBHC (7191), HVOP (8135), HVTB (8146), HKID (7186) and HVCT (8165).

The RDF supports three military hospitals and five brigade clinics throughout the country. In FY 2005, Drew University began working in two military hospitals and three brigade clinics with EP support. This support included TA and training on ARV treatment, palliative care, M&E, and lab infrastructure. This support has been expanded to cover the entire clinical package - ARV services, TB/HIV, PMTCT, Palliative Care and Prevention for Positives. In collaboration with CHAMP, Drew will link to community services surrounding the military facilities, especially for OVC. Drew will receive drug procurement from PFSCM. In line with national policies, the military hospitals will use performance-based financing as incentives for facilities.

Because the EP will initiate a standard prevention for positive package for beneficiaries starting in FY 2007, Drew University will include these interventions as it scales up in the military facilities.

In FY 2007, Drew University will work with the RDF to improve HIV care for military personnel, their partners and families, and community members who live in the surrounding areas. Drew University will provide TA to RDF to design a prevention campaign targeting PLWHA individuals receiving HIV care and treatment at RDF sites. The overall goal of this activity is to reduce the risk of further HIV transmission among discordant couples. New preventions will be prevented through BCC with a focus on AB messages. As part of the prevention for positives initiative, soldiers are encouraged to abstain and be faithful while they are away from their spouses and partners. Ten thousand individuals will be reached with AB messages. Prevention of alcohol abuse and the link between alcohol use, sexual risk behaviors and gender-based violence are a focus of the peer education trainings and IEC materials promoting AB.

In collaboration with the DMS, Drew University will implement an AB campaign and continue trainings and TA to anti-AIDS-clubs and peer educators. One hundred peer educators will be trained to provide ABC prevention messages that address the links between HIV, alcohol and gender-based-violence and will stress AB or C depending on the different sub-groups. Peer educators will encourage married members of the RDF to practice abstinence while on duty and stay faithful to their spouses.

These activities addresses the key legislative issues of gender, especially on male norms and reducing violence. The activity also reflects the Rwanda National Plan for HIV infection prevention and the Rwanda EP five-year strategy for averting 157,000 new infections by 2010.

This activity relates to HTXS (7190), HBHC (7191), HVAB (8125), HVCT (8165) and HVTB (8146).

The RDF supports three military hospitals and three brigade clinics throughout the country. In FY 2005, Drew University began working in two military hospitals and three brigade clinics with EP support. This support included TA and training on ARV treatment, palliative care, M&E, and lab infrastructure. This support has been expanded to cover the entire clinical package - ARV services, TB/HIV, PMTCT, palliative care and prevention for positives. In collaboration with CHAMP, Drew will link to community services surrounding the military facilities, especially for OVC. Drew will receive drug procurement from PFSCM. In line with national policy, the military hospitals will use PBF as incentives for facilities.

In FY 2007, Drew University will work with the RDF to improve HIV care for 2,000 military personnel, their partners and families, and community members who live in the surrounding areas. Drew University will provide TA to the RDF to design a prevention campaign targeting PLWHA receiving HIV care and treatment at RDF sites. The overall goal is to reduce HIV transmission among discordant couples, and prevent new HIV infections between PLWHA and HIV negative individuals.

Through workshops for PLWHA, Drew University, in collaboration with PSI, will train RDF providers to integrate condoms and to promote the reduction of sexual partners and correct and consistent condom use.

Drew University will work with the RDF to train members of PLWHA associations to become peer educators in order to strengthen their capacity in treatment adherence, prevention of HIV transmission, and link HIV to alcohol and violence. Drew University will link civil-military associations of PLWHA to national umbrella of PLWHA associations.

This activity supports the key legislative issues of gender, particularly male norms, reducing violence, and stigma and discrimination. This activity reflects the Rwanda National Plan for HIV infection prevention and the Rwanda EP five-year strategy for averting 157,000 new infections by 2010.

With this additional funding, Drew University will continue to improve the capacity of the Rwandan Defense Force to provide HIV treatment and care for military personnel, their partners and families, and community members who live in the surrounding areas. Throughout the twelve (12) RDF brigades, Drew University will provide technical assistance to RDF to strengthen linkages between community-based and clinic-based HIV care services. At brigade and/or community levels, this additional funding will allow Drew to support the formation of civil-military allied associations of HIV+ people. In addition, Drew will train an additional 110 association members in provision of home-based care, provide nutritional counseling and support, provide training for HIV prevention for positives and caregivers, distribution and use of care packages, support income generating activities, train members on adherence and refer HIV+ cases to health facilities in order to reach an additional 1,200 PLWHA.

This activity relates to activities in HTXS (7190), HBHC (7191, 8716), HVAB (8125), HVOP (8135), HVCT (8165), HVTB (8146), HLAB (8189)

In the RDF health network there are three military hospitals and five brigade clinics throughout the country. Drew University began working in two military hospitals and three brigade clinics in FY 2005 with EP support. The support modalities include TA and training on ARV and palliative care, M&E, and laboratory infrastructure. Drew collaborates with CHAMP for services in military communities such as OVC support, and receives drug procurement from PFSCM. In line with national policies, the hospitals incorporate performance-based financing as incentives for facilities.

In FY 2006, Drew University is improving the capacity of the RDF to provide HIV treatment and care to 1,300 military personnel, their partners and families, and community members who live in the surrounding areas. The package includes clinical staging and baseline CD4 count for all patients, follow-up CD4 count every six months, prevention of OIs through CTX prophylaxis to eligible patients, psychosocial counseling including referrals for HIV-positive victims of domestic violence and referrals of PLWHA in care to community-based palliative care services.

In FY 2007, Drew University will provide the same package of palliative care to 2,530 PLWHA enrolled at three military hospitals and three brigade clinics. Drew University will provide TA to RDF to strengthen linkages between community-based and clinic-based HIV care services. At brigade and community levels, Drew will support the formation of civil-military allied associations of PLWHA and train members in provision of a range of services. These HBC services include nutritional counseling, assessment and management of malnutrition through provision of micronutrient and multivitamin supplements and links to Title II partners for food wrap-around for clinically eligible PLWHA, provision of HIV prevention counseling for positives, and training of caregivers in the management of PLWHA.

In addition, peer educators will be trained to provide social support to brigade and community members through interactive, experience-sharing group workshops. These workshops will be organized to increase treatment adherence and share success stories witnessed during the course of HIV care therapy. At the clinic level, Drew University will train providers in, and increase access to STI, OI and mental health diagnosis and treatment, by integrating these services into three brigade-level clinics. Forty individuals will be trained to provide HIV-related palliative care. In line with national policies to promote sustainability, the hospitals will begin performance-based financing activities.

In collaboration with CHAMP, GFATM and PMI, Drew University will refer 2,530 PLWHA and their families for malaria prevention services including provision of bed nets.

Drew University will assist the RDF to strengthen referral to community-based support groups for improved treatment adherence and increased access to non-clinical HIV care services. Ngarama military hospital will provide a full package of HIV care services. Drew University will assist the RDF to decentralize and integrate HIV basic health care services in three brigade clinics at Musanze in the north, Ngoma in the east and Muhanga.

Through PFSCM, Drew provides OI-related drugs, CD4 testing, and OI diagnostics for the clinical management of PLWHA enrolled in care. Drew will work with PFSCM and RPM-Plus

to ensure appropriate stock management, inventory control, and storage for all USG-procured commodities at Drew-supported sites.

This activity is related to other DOD funded activities under HBHC (7191), HTXS (7190), HVOP (8135), HLAB (7190), HVAB (7230).

In the RDF health network there are three military hospitals and five brigade clinics throughout the country. Drew University began working in two military hospitals and three brigade clinics in FY 2005 with EP support. The support modalities include TA and training on ARV and palliative care, M&E, and laboratory infrastructure. Drew collaborates with CHAMP for services in military communities such as OVC support, and receives drug procurement from PFSCM. In line with national policies, the hospitals incorporate performance-based financing as incentives for facilities.

In FY 2007, Drew University will work with the MOH and RDF to train health providers and improve the quality of TB integration in HIV treatment for HIV positive military personnel and civilians receiving care in the military. Drew University will screen 75% of TB patients for HIV. In addition, they will improve the infrastructure at six RDF hospitals and brigade clinics and train 40 RDF health providers to diagnose, treat and through an established information system, monitor and report TB progression trends. Drew University will ensure that the provision of preventive cotrimoxazole prophylaxis is integrated into a HIV care package.

Drew University will support facilities to strengthen referrals mechanisms within the same facility and between facilities to enable patients diagnosed with TB and HIV to adhere to TB treatment via DOTS, and have access to cotrimoxazole prophylaxis and baseline and follow-up CD4 and ART if eligible.

PBF is a major component of the Rwanda EP strategy for ensuring long-term sustainability and maximizing performance and quality of services. In coordination with the HIV PBF project, Drew will shift some of their support from input to output financing based on sites' performance in improving key national HIV performance and quality indicators. Examples of quality indicators include correctly filling stock control cards in X-ray departments, the percentage of TB lab exams that are corroborated during quarterly controls, the number of X-rays of good quality with correct diagnosis and report in patient file, and the number of complete series of AFBs correctly done. Payment of indicators is linked to the quality of general health services through adjustments of payments based on the score obtained using the standardized national Quality Supervision tool and a performance incentive for the production of more than agreed upon quantities of each indicator.

In addition, Drew University through regular supervision to supported sites will ensure that TB/HIV data are recorded and reported following national guidelines and that staff conduct quarterly M&E meetings with PLWA associations and community health workers to analyze data and use them for program quality improvement.

This activity relates to activities in HBHC (7191), HTXS (7190), HVOP (8135), HLAB (7190), HVAB (7230), and HVCT (8167).

In the RDF health network there are three military hospitals and five brigade clinics throughout the country. Drew University began working in two military hospitals and three brigade clinics in FY 2005 with EP support. The support modalities include TA and training on ARV and palliative care, M&E, and laboratory infrastructure. Drew collaborates with CHAMP for services in military communities such as OVC support, and receives drug procurement from PFSCM. In line with national policies, the hospitals incorporate performance-based financing as incentives for facilities.

In FY 2007, Drew University will integrate CT services at the brigade level which will enable the RDF to conduct PIT and routine HIV testing of 8,000 individuals at three military hospitals and three brigade clinics. CT services will ensure confidentiality, minimize stigma and discrimination, and reach those individuals most likely to be infected. A total of 30 doctors, nurses and social workers at Drew sites will be trained in PIT and CT.

In addition, Drew University-supported facility-based CT sites will collaborate with PSI's mobile CT unit to conduct home CT services to soldiers at the battalion and company levels, as well as for their spouses and family members tracked through the established information systems. This exercise will facilitate the identification of discordant couples and enhance HIV care, particularly prevention for positives.

In order to counsel and test those individuals most likely to be HIV-positive, nine new "contact counselors" will be recruited to conduct contact tracing of all patients who test positive for HIV at Drew sites. Contact counselors will be responsible for accompanying HIV-positive clients to their community, encouraging their spouse and family members to be tested, providing HIV testing, and identifying discordant couples who are in need of intensive prevention counseling. As Rwanda moves towards a disease registry-based system, individuals receiving services through these family and couples CT efforts will be entered into a database that utilizes the national identification number as the basis of a case report. Moreover, this system will permit the compilation of a sub-registry of HIV-discordant couples to allow expanded activities in prevention for seropositives. This contact tracing activity will also be supported by CDC who will help establish policies and procedures and coordinate related M&E activities.

To strengthen the linkage between services, Drew University and PSI will use a database to record all CT-related data, and PDAs will be used to record demographic data of HIV-positive clients during post-test counseling, including setting appointments for the client to HIV staging and evaluation at a referral site. On-site training and supervision in HIV counseling and testing will be provided to RDF providers and Drew University will second technical staff to new CT sites in RDF, if needed.

PBF is a major component of the Rwanda EP strategy for ensuring long-term sustainability and maximizing performance and quality of services. In coordination with the HIV PBF project, Drew will shift 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 CT 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.

PFSCM will procure HIV test kits and supplies for all sites. Drew will work with PFSCM and district pharmacies to ensure that all sites have adequate and secure storage facilities as well as inventory monitoring and tracking systems for the test kits.

This activity supports the EP five-year plan by scaling up CT services and providing integrated treatment, care, and prevention services to high risk groups.

This activity relates to HBHC (7191, 7187), HVOP (8135), HKID (7186), MTCT (8122), HVTB (8146), HVCT (8165), HTXD (8170), HTXS (7213), and HLAB (7224, 7192, 8189).

RDF has three military hospitals and five brigade clinics throughout the country. In FY 2006, Drew University supported two military hospitals to provide a comprehensive package of ART services, including ARV treatment, follow-up CD4 count every six months, viral load to patients with decreased or stable CD4 after nine months of HAART, management of ARV drug side effects and patients' referral to community-based palliative care.

In FY 2007, Drew University will provide the same package to 1,170 PLWHA in three new brigade clinics and one additional military hospital. Drew will improve physical infrastructure, train providers, second technical staff, and supply materials, consumables, and equipment. At one military hospital, Drew will support the district health team to cover the civilian network of decentralized ART services within the hospital catchment area. Drew will collaborate with CHAMP to provide community services in surrounding areas, PFSCM for drugs and other commodities, and MSH to improve capacity in drug logistic management. Drew will also support PLWHA associations to promote ART services and reduce stigma.

In addition, Drew will strengthen district and facility level capacity for data collection, reporting and use with a focus on ARV drugs management, HIV case management, and improved quality implementation and program evaluation. Sites will generate routine summary reports of patient-level data and will interpret that data to inform their programmatic operations. Drew will also organize periodic M&E workshops for all supported sites to discuss the collection and use of data at the site-level.

These activities support the EP five-year strategy for national scale-up and the Rwandan Government ART decentralization plan, and address key legislative issues related to gender, stigma and discrimination.

This activity relates to HVAB (7230), HVOP (8135), HVCT (8165), HTXS (7190), and HLAB (7190).

The RDF has three military hospitals and five brigade clinics throughout the country. In FY 2006, Drew University is supporting two military hospitals and working with the RDF to improve IT infrastructure for data entry and patient monitoring at hospital and brigade clinics by training 20 RDF personnel in strategic information. This support will expand the RDF's capacity to follow the health status of HIV-positive soldiers and civilians receiving care within the military health system, improve referrals, and the quality of treatment, prevention and care services.

In FY 2007, Drew will continue these activities and train 45 data entry technicians in data collection, analysis and use. In addition, Drew University will provide materials and TA to improve the military HMIS in order to track routine HIV testing of all military personnel. Drew will assist the RDF in the implementation of existing GOR data reporting tools to monitor HIV treatment, care and outreach activities. To provide better care and referrals for military spouses, partners and family members, Drew will support RDF to implement a family-centered approach.

To strengthen and monitor services, a steering committee linking RDF, TRAC and partners will be established to review and utilize data to improve the RDF healthcare system, direct policies, and improve the quality and cost-effectiveness of HIV treatment and care in RDF settings. To improve access to patient data, RDF will develop a system to allow HIV treatment and care providers at all RDF sites to update data at a main server using access codes and create a coding system for all patients receiving care in RDF health facilities. Drew will pilot the introduction of personal digital assistants to increase the use of electronic medical records, enabling providers to record firsthand health information of HIV-positive patients generated through one or more provider-patient encounters. Drew will train RDF health providers and policymakers to analyze and use collected data to streamline clinicians' workflow in HIV services, monitor quality, and facilitate the identification of gaps in HIV services.

This activity reflects the ideas presented in the EP Five-Year HIV/AIDS Strategy in Rwanda and the GOR National multi-sectoral strategic plan for HIV/AIDS Control (2005-2009) by directly supporting the development of a sustainable strategic information system for the national HIV/AIDS program.