Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4358
Country/Region: Rwanda
Year: 2007
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $3,226,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $83,000

This activity relates to MTCT activity 7244.

In FY 2007, CDC will support the position of PMTCT Officer (health specialist) to oversee planning, implementation, and M&E of all USG activities in the area of PMTCT, as well as provide technical input to the MOH through technical working groups. CDC will continue to support the MOH and TRAC to integrate PMTCT services and PMI into the MCH system. In addition, CDC will continue to assist TRAC in implementing the scale-up plan for early HIV infant HIV diagnosis by reinforcing the M&E of this program and by assisting TRAC in the revision of tools for infant follow-up as needed.

CDC will support TRAC in reinforcing the M&E system to ensure adherence to the new PMTCT regimen through TA from CDC HQ for aspects of program monitoring such as revision of M&E tools and documentation of best practices implemented by different implementing partners.

These activities fully support PMTCT in line with Rwanda EP five-year strategy for prevention.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $0

Reprogramming 8/07: This activity has been reprogrammed to a partner.

This activity relates to HVAB (7226) and HVOP (7232).

During FY 2006, PSI collaborated with the MINEDUC to strengthen the HIV/AIDS competencies of teachers and anti-AIDS clubs through BCC and Life Skills training of peer educators. The Healthy Schools Initiative also targeted youth with abstinence BCC campaigns, which utilized interpersonal communication sessions and mobile video shows to promote safer sexual behavior messages. PSI developed a parent-child curriculum aimed at improving communication about HIV/AIDS and sexuality which will be used to train community-based facilitators to work with parents and religious leaders.

In FY 2007, PSI will target a larger portion of Rwandan school youth with prevention messages using midlevel media in at least 200 secondary schools. Mobile video shows will present A and B messages that focus on improved communication between boys and girls to strengthen negotiation skills, increased ability to resist peer pressure, the risks of cross-generational and transactional sex, and better understanding of gender equality. PSI will also continue production of the ABAJENE! youth call-in radio shows and the ABAJENE! youth magazine to reinforce the prevention messages communicated during mobile presentations.

The first component of this activity involves providing two to three short-term TA visits from CDC headquarters prevention specialists to support PSI's interventions with adolescents in order to ensure effective programs and assist with M&E components.

The second component will provide support to the Rwandan MINEDUC. While the MINEDUC is heavily involved in PSI's school-based HIV/AIDS prevention activities, human resources at the Ministry are scarce. There is currently one person, the Coordinator of HIV/AIDS programs, who is responsible for planning, coordination, and monitoring of all HIV/AIDS activities in the education sector. The Ministry would greatly benefit from two additional positions in the HIV/AIDS department. These two locally-hired FTE positions will be supported by CDC and seconded to the MINEDUC under this activity. The Planning and Evaluation Officer will help plan, coordinate, and evaluate all HIV/AIDS activities in the education sector, including the Healthy Schools Initiative. The Community Mobilization Officer will actively collaborate with partners as well as ensure implementation of community-based HIV/AIDS activities in the education sector.

Assistance to the Healthy Schools Initiative and MINEDUC reflects the ideas presented in the Rwanda EP five-year strategy and the National Prevention Plan by supporting abstinence and faithfulness programs that target secondary school youth and by building the capacity of coordinating entities and strengthening collaboration with government partners.

Funding for Care: TB/HIV (HVTB): $69,000

Reprogramming 8/07: This activy has been reduced and CDC Rwanda will only coordinate and funds technical assistance from CDC Atlanta to conduct public health evaluations in TB.HIV and TB lab upgrading in coordination with Ministry of health and implementing partners

This activity relates to activities in HTXS (7169) and HVTB (8664).

In FY 2006, CDC in collaboration with WHO and Columbia, supported the MOH in TB/HIV collaborative activities by revising guidelines, tools and training materials at the central level. CDC worked closely with GOR and WHO to develop an integrated work plan for the two-year WHO/USG TB/HIV project and continues to support this project in an advisory role. CDC also provided TA for targeted evaluations conducted by PNILT and TRAC to inform national TB/HIV program policy and implementation of guidelines. A baseline evaluation of TB patients' acceptance of HIV-testing and access to HIV care and treatment was conducted and showed that of 207 TB patients interviewed at 23 geographically representative sites, 96% accepted or would be willing to accept an HIV test, if offered. Prior to implementation of the national TB/HIV policy and guidelines, HIV test results were only recorded for half of patients and there was no standard recording of other HIV-related data, suggesting that HIV-positive TB patients may not have access to cotrimoxazole prophylaxis or HIV care and treatment. Among TB patients with known HIV status, mortality for HIV-positive patients was six times greater during TB treatment than for HIV-negative TB patients. This evaluation, led by PNILT, provided important baseline data and recommendations for implementing TB/HIV activities and the national policy was revised to include providing cotrimoxazole to all HIV-positive TB patients. USG, through TA from CDC HQ and field staff, also provided TA for an evaluation by PNILT to identify how patients are diagnosed with smear-negative and extrapulmonary TB in Rwanda. Results of this evaluation are expected by the end of 2006 and will be used to inform and recommend changes to the current national guidelines to improve the timely diagnosis of TB among PLWHA. Rwanda has adopted a five-part screening questionnaire to screen adult PLWHA for TB.

Currently there are no national guidelines on screening HIV-positive children for TB. In FY 2006, CDC provided technical assistance to TRAC and PNILT to design and begin a public health evaluation to screen HIV-positive children for TB. Data will be used in conjunction with the experience from national pediatric experts and USG partners to develop an effective TB screening tool for all HIV-positive children.

In FY 2007 CDC will continue to provide short-term TA to USG partners, TRAC and PNILT to plan, implement and assess the impact of programmatic TB/HIV activities using national recording and reporting tools. CDC in collaboration with TRAC, PNILT and Columbia will establish a surveillance system for TB and HIV at the Kigali national prison and Gisenyi regional prison. All prisoners will be offered HIV counseling and testing and will be screened for TB. Prisoners found to be HIV-positive will be enrolled into care and treatment. Those found to have active TB will be treated through the national program under DOTS. In FY 2007 CDC will also provide TA and funds to TRAC and PNILT to supervise the scale-up of the TB/HIV surveillance and ensure care and appropriate treatment after discharge at an additional six prisons in Rwanda in coordination with the local DHTs. CDC will design with TRAC and PNILT a protocol for follow-up of prisoners after release.

CDC will provide short-term TA for implementation of the national infection control guidelines to be developed by PNILT through the WHO/USG-funded TB/HIV activity. Activities will focus on improving infection control at CHK, NRL, and sites caring for HIV-positive MDR TB patients. CDC will also support TA to PNILT to implement the electronic TB register in Rwanda and to link it to the TRACNet database.

In order to meet the PEPFAR priority of providing quality smear microscopy services and effective TB diagnostic services for PLWHA, CDC will support short-term TB laboratory TA to work with NRL and Columbia University to enhance the performance of the smear microscopy EQA system and the quality of culture and drug sensitivity testing services. Surveillance for extremely drug-resistant TB (XDR) will be conducted at CHK among TB patients that are failing TB treatment. Currently only two lab technicians are able to perform TB cultures and run first-line at NRL. CDC will provide short-term support to train

one additional lab technician in performing cultures and drug sensitivity testing at the supranational reference lab in Antwerp.

Extrapulmonary TB (ETB) is more strongly HIV-related than pulmonary TB (PTB), with combined ETB and PTB especially suggestive of underlying HIV-infection. Patients with HIV-related ETB often have disseminated disease and are at high risk of rapid clinical deterioration and death. Prompt diagnosis and treatment is essential because only approximately one half of HIV-positive patients that die from disseminated TB are diagnosed before death. In both 2004 and 2005, CHK reported a larger number of extrapulmonary TB cases than any other reference hospital or health district in Rwanda, with over 60% of all TB patients diagnosed with ETB. Diagnostic tests for ETB are severely limited in Rwanda. In FY 2007 CDC will provide support to the MOH to establish histology and pathology services at the CHK laboratory to improve the prompt diagnosis of ETB through TA, training and equipment. Simplified standardized clinical management guidelines for the most common and serious forms of ETB will be implemented. Immune reconstitution occurs rapidly in most HIV-positive adults who are started on ART and can lead to clinical signs and symptoms of active TB. There is little known about the burden of the immune reconstitution inflammatory syndrome (IRIS) in Rwanda. Rwanda has adopted guidelines to screen for TB prior to initiating ART to minimize IRIS morbidity and mortality. In close collaboration with USG partners, CDC will also provide TA to TRAC to establish TB IRIS surveillance.

In order to expand, monitor and improve TB/HIV services, one long-term TB/HIV technical advisor will be recruited and seconded to TRAC to oversee the implementation and expansion of integrated TB/HIV activities in HIV care and treatment programs. TA will include support for implementation of intensified TB case-finding among PLWHA, prioritizing implementation in care and treatment services and later expanding intensified TB case finding to PMTCT, VCT and palliative care services. The technical advisor will work closely with TRAC to fully implement, monitor and evaluate TB screening indicators to routinely assess program performance and provide training and supervision.

CDC support to TRAC, PNILT and USG partners in coordination with WHO will ensure quality and scale-up of TB HIV collaborative activities. This activity supports the Rwandan national policy for integration of TB and HIV services.

Funding for Testing: HIV Testing and Counseling (HVCT): $440,000

This activity is related to activities in HVCT (7242, 8169, 8167, 7178, 8164, 8168).

In FY 2006, CDC is training and deploying one Mobile VCT team to implement a testing campaign in secondary schools in Kigali and Gitarama as part of the Healthy Schools Initiative in coordination with PSI's school-based prevention activities and demand-creation for CT. Eleven thousand secondary students are being reached with testing services through MVCT.

The GOR's overall strategy continues to be prioritizing support for facility-based CT and expansion of new sites. However, GOR endorses selective use of mobile CT to reach mobile populations such as the uniformed services, CSWs and their clients, prisoners, men who have sex with men, truck drivers, and itinerant workers (fishermen, tea plantation workers, etc) - high-risk populations that are likely to have higher than average seroprevalence rates. Students are considered to be a non-mobile population with adequate access to facility-based CT, so in 2007 this mobile unit will be used with the explicit goal of outreach from facility-based CT and collecting strategic information on high-risk subgroups.

The USG will work with the GOR and other key partners to field an MVCT team to provide high quality, client-initiated CT services that ensure confidentiality, minimize stigma and discrimination, and reach those individuals most likely to be infected. Innovative approaches will be used to reach these populations, such as evening testing hours and testing in strategic locations in order to best access the clients. Counseling messages will emphasize prevention, including abstinence and reduction of partners, alcohol reduction, GBV sensitization, disclosure of test results, and follow-up care.

CDC's mobile team will coordinate schedules, target populations, and locations of testing with other EP partners conducting MVCT. CDC will bring its technical expertise to these coordinated MVCT activities, utilizing in-country and short-term international TA to support M&E, laboratory protocols, and strategic information collection.

In order to ensure proper referral to care, the MVCT team will identify ARV sites in proximity of each MVCT testing location and provide this information and actively refer each HIV-positive client, and a follow-up system will be used to determine what percentage of clients actually accessed care. This will be implemented in accordance with GOR standards and guidelines.

This activity also includes support for a Program Officer for Counseling and Testing in the CDC office. This long-term technical position will provide regular oversight of the MVCT staff and activities, including supervision and M&E. Also supported under this activity are the MVCT team members: Coordinator, Counselor-Trainer, Community Mobilizer, Laboratory Technician, two full-time counselors, and six part-time counselors. This team, already in place and supported by 2006 EP funding, will plan, coordinate, execute, and assist with evaluation of the activities. The Counselor-Trainer, in coordination with TRAC's PMTCT/CT unit, will conduct CT trainings for all newly hired counselors. Refresher trainings will also be provided as needed throughout the year.

Funding for this activity also includes policy development and M&E for implementation of family and couples CT which will be implemented by USG clinical partners. CDC, in collaboration with TRAC and USG clinical partners, will formulate and adapt procedures for CT that address sensitive issues surrounding contact tracing and partner notification. "Contact counselors" supported by clinical partners will actively provide supportive counseling and testing to family members and other sexual contacts for increased referrals for testing and treatment. Additionally, this activity will encompass the collection of programmatic data useful for longitudinal follow-up of families and sexual dyads.

PFSCM will procure HIV test kits and supplies for all sites. CDC will work with PFSCM and district pharmacies to ensure inventory monitoring and tracking systems for the test kits.

This MVCT activity reflects the ideas presented in the Rwanda EP five-year strategy and the National Prevention Plan by scaling-up CT services, increasing the availability of CT services outside of health facilities, and providing prevention messages to high-risk groups.

Funding for Treatment: ARV Drugs (HTXD): $0

Reprogramming 8/07: This activity has been abandoned.

This activity relates to HTXS (7213), HTXD (8170), OHPS (7212, 9638) and HVSI (7248).

The overall goal of this activity is to provide a simple, small-scale program of passive surveillance for adverse events among Rwandan patients who receive EP-distributed pharmaceuticals.

The EP relies heavily upon pharmaceutical interventions to ameliorate disease and interrupt viral transmission. However, these drugs often have secondary adverse effects that negate their primary therapeutic benefits. While the antiretroviral and anti-infective drugs employed by the EP are well characterized, many could have adverse effects that remain unrecognized in special clinical circumstances.

In FY 2007, FDA will provide TA in collaboration with PMI and RPM+ to the NDA, TRAC and APHAR to establish a small-scale program of passive surveillance for adverse events. Through short term TA, FDA will train caregivers in select hospitals in the use of simplified reporting forms, as well as a GOR-based analyst in their appropriate interpretation. In addition, FDA will provide periodic QA and supervision to those health care providers to ensure appropriate completion of the reports, quality of data, and reporting to the NDA. While this innovation is very small in both scale and budget, it represents a significant innovation as it would be the first categorical drug safety program instituted in Rwanda.

This activity reflects the ideas presented in the Rwanda EP five-year strategy and the National Prevention Plan by providing quality assurance of treatment commodities, and strengthening the quality of ARV services.

Table 3.3.11: Program Planning Overview Program Area: HIV/AIDS Treatment/ARV Services Budget Code: HTXS Program Area Code: 11 Total Planned Funding for Program Area: $ 22,893,463.00

Program Area Context:

As of June 30, 2006, 25,931 patients have been put on ARV treatment, including 2,124 children, at 116 sites across Rwanda. Approximately 1% of patients are on second line regimens and 15% of pregnant women are on HAART as per the new national PMTCT protocol. The national plan expects to achieve near universal access by providing ART services to 57,820 patients, including 7,612 pediatric patients by the end of 2007 - surpassing the EP target of 50,000 on ART by the end of FY 2009.

Along with GFATM and World Bank MAP, the EP has been one of the major programs supporting the National Treatment Plan since 2004. With the GOR decision to shift World Bank support away from HIV/AIDS services, EP represents an even larger share of the support to the national program by taking on MAP sites within EP districts and offering services in 22 of the 30 districts in Rwanda. In addition, EP supports ART decentralization from district hospital to health centers through 1) central level support to TRAC, NRL and MOH to develop and revise policies, adapt guidelines, update training curricula, and supervise decentralized services; 2) technical and financial support to the DHTs to strengthen linkages, referral systems, and communications; and 3) support to health center ART sites where nurses provide patient care with district hospital physician oversight.

In FY 2005 and FY 2006, FHI successfully piloted an expanded role of nurses in the provision of ARV care. District hospital physicians support nurses to manage ARV cases through regular visits, mentoring, remote support via telephone for urgent questions and use of simplified protocols. This decentralized model of care will be implemented more broadly by all EP partners in FY 2007. In addition, USG will strengthen nursing training through pre-and in-service training in HIV/AIDS care and treatment.

In FY 2007, the EP will continue supporting all levels of the decentralized ART network, starting from central level institutions and extending to the community as the most peripheral point of service. The EP will scale-up ART support by putting 36,621 eligible patients, including 3,662 children, on ART at 135 EP-supported sites of which 34 are new in FY 2007. The EP will support ART services in all 11 prisons within EP districts and two refugee camps. To expand quality pediatric care, Rwanda's few available pediatricians will mentor other clinical providers, using the Columbia UTAP model developed in FY 2006. Starting in FY 2006 and expanding in FY 2007, USG will improve rational use of ARVs through the creation of DTCs at hospitals and the establishment of a national level DTC. In line with GOR policy, the EP will expand performance-based financing, piloted by MSH in FY 2006, to all EP-supported sites. Implementing partners will gradually shift from input financing to output financing with the purchase of improved performance for specific HIV indicators at the hospital, health center and community.

At the central level, the EP will continue supporting TRAC to revise national guidelines, tools, curricula, and training of trainers, with an emphasis on pediatric care and informed by the latest research. To further improve the quality of services, TRAC-led supervisions will include donors and implementing partners, and regular feedback will be provided to sites. The EP will also continue supporting the planning and decentralization unit of the MOH to support district health teams in their new decision-making roles in strategic planning and budgeting.

At the district level, EP partners will provide a package of support to 28 DHTs in 22 districts to strengthen their capacity to coordinate an effective network of ARV and other HIV/AIDS medical services. This network focuses on maximizing access and improving quality of care at the most decentralized level. Implementing partners will provide a basic package of financial and technical support to DHTs to strengthen linkages, referral systems, transport, communications and financing systems necessary to support an effective ART and other HIV/AIDS care network. DHTs are responsible for assuring access of patients to quality HIV/AIDS care, coordination of lab services, organization of specific care components, and good management of resources.

At site level, EP partners will provide a standardized package of ARV services through support and development of a coordinated network of HIV/AIDS services linking ART with PMTCT and other services. Following a tiered approach to service delivery (network model) USG partners will provide comprehensive ART services at larger facilities and a basic package of ART services at satellite health centers. Nurses will serve as the primary HIV service provider at these more distal sites of the health care system and have physician back-up at district level facilities. Services provided at the health center level will include: identification of HIV infected persons who may be eligible for ART, follow-up of patients on ART and referral of complex cases. Additionally, EP partners will continue to focus on ensuring the expansion and monitoring of pediatric HIV-related outpatient services, including CTX prophylaxis, early infant diagnosis, infant feeding education and ARV treatment to eligible infants and children. Moreover, partners will streamline the model of pediatric enrollment through early diagnosis by using specialized pediatricians to train general practitioners and reinforcing linkages to other consultation services such as nutrition, vaccinations, and well-child visits. Additionally, partners will promote a service environment sensitive to issues that may limit women's access to HIV/AIDS related services, including treatment. The EP will improve geographic access by expanding the number of full ART sites and increasing the services provided in satellite ART sites where physicians have less frequent rotations but patients on ART could access a full range of routine ART management services near their homes.

At the community level, partners will ensure continuum of care and adherence by using peer support groups, community mobilization, home visits, community-based registers, referral slips, patient cards and other monitoring tools to facilitate transfer of information between facilities and communities for better follow-up and referrals. HIV case managers at sites will train and supervise community volunteers including CHWs, PLWHA association members, and other caretakers, in collaboration with CHAMP. In addition to basic palliative care, these community volunteers will provide adherence counseling, patient education, and referrals for drug side effect awareness and management. Moreover, case managers will ensure referrals of pediatric patients identified from PMTCT programs, TB services, PLWHA associations, and malnutrition centers as increasing pediatric patient enrollment is a priority for all EP clinical partners in FY 2007. Since the GOR has mandated that community workers must serve on a voluntary basis, USG partners will motivate community volunteers through performance-based incentive schemes.

In line with Rwanda EP 5-year strategy and sustainability goals, all EP implementing partners will provide the same package of support at district, health facility and community level to ensure all patients receive the same standard of quality care. At the central level, the EP will capitalize on different partners' comparative advantages to provide targeted support to the national program. Consolidating lessons learned from the different programs piloted in the past, the EP has harmonized its support across all clinical implementing partners, with minor variations for those serving special populations such as refugees and the military. By so doing, the EP increases efficiencies and assures equity in the provision of services.

Program Area Target: Number of service outlets providing antiretroviral therapy 136 Number of individuals who ever received antiretroviral therapy by the end of 38,035 the reporting period Number of individuals receiving antiretroviral therapy by the end of the 36,946 reporting period Number of individuals newly initiating antiretroviral therapy during the 13,810 reporting period Total number of health workers trained to deliver ART services, according to 2,024 national and/or international standards

Table 3.3.11:

Funding for Treatment: Adult Treatment (HTXS): $500,000

This activity relates to HTXS (7246, 7158, 7161, 7174, 7176), MTCT (8184), HBHC (8139), and HVTB (7266).

In FY 2007, CDC will continue the support of a Care and Treatment Officer who oversees planning, implementation, and M&E of CDC-direct and EP partner activities, the implementation of the national ART impact evaluation, and short-term TA for specialized areas of the EP program such as pediatric AIDS.

The long term care and treatment officer will assist TRAC in the coordination of care and treatment activities and support integration of HIV care and treatment services into the general health care system by co-chairing the national integration TWG and facilitating joint site supervisions. In addition, CDC Rwanda will assist MOH to adapt training curricula in integrated activities such as TB, nutrition, malaria, and MCH.

In addition, CDC Rwanda will continue to support the impact evaluation of the national ART program, which was introduced in FY 2006 with a two-part protocol. Part one includes the evaluation of patient retention, weight, and CD4 outcomes at six and twelve months based on available data abstracted from medical records. Part two includes the evaluation of viral load suppression at six and twelve months based on RNA PCR determination. This evaluation will be repeated annually to track program quality over time.

CDC will also continue to support TRAC in care and treatment for HIV-positive children. Through short-term TA from CDC HQ, pediatric HIV care will be integrated into MCH and PMTCT programs through the development of tools and reinforcement of M&E systems.

This activity is in line with the Rwanda EP five-year strategy to develop human capacity and build sustainability.

Funding for Laboratory Infrastructure (HLAB): $320,000

This activity relates to activities in HLAB (7244, 7172, 7154, 8189).

CDC provides direct support for laboratory infrastructure activities through CDC technical staff in-country as well as through short-term TA from CDC headquarters. In FY 2006, CDC's DPDx group developed a set of training materials and conducted procurement of supplies needed for a week-long training of trainers in parasitology diagnostics to be conducted in November 2006. CDC also provided TA for the development of the laboratory component of an ongoing national ART program evaluation. CDC is currently recruiting a full time laboratory advisor to be placed at the CDC office.

In FY 2007, CDC will continue direct support for laboratory infrastructure activities through the long-term lab position described above. This laboratory advisor will provide day-to-day oversight of EP-funded lab partner activities, including the NRL cooperative agreement and other clinical partners. The lab position will also provide ongoing assistance with development and implementation of national laboratory policy. Because the current capacity of district hospital laboratories to diagnose OIs remains limited, CDC will continue to support laboratory capacity for diagnosis through CDC's DPDx program for diagnosis of parasitic diseases. This support will include procurement of diagnostic supplies and ongoing training at NRL for technician trainers, as well as TA for improving NRL's supervision capacity and systems, particularly in malaria diagnosis. CDC will continue to provide TA to lab professionals in evaluating new techniques for specimen collection for viral load testing, and for applying these new techniques for public health program evaluation. CDC will work closely with Columbia University to adapt laboratory management information system software previously developed by CDC in other countries for use in Rwanda's NRL and select district hospitals.

CDC technical support to NRL is consistent with Rwanda EP five-year strategic goals of strengthening NRL capacity to manage a national network of laboratories, and standardization of technical approaches and QA of HIV-related services through a network model. DPDX's ongoing procurement, training and QA activities will provide an excellent platform upon which to further strengthen laboratory capacity and systems under PMI.

Funding for Strategic Information (HVSI): $649,000

PEPFAR Rwanda has supported provision of internet connectivity to 30 health facilities in Rwanda. This will increase the capacity of several EP supported sites to deploy and use electronic health information systems (TRACnet, ETRnet, OpenMRS) etc to avail rich data to program managers at district and national level, and provide better services to patients receiving care. The additional funds will allow CDC to provide internet connectivity to an additional 34 sites (64 total), thereby achieving 100% availability of connectivity in all EP supported sites in Rwanda. The funds for this activity are reprogrammed from activities 8139 ($25K) and 9388 ($75K).

This activity relates to HVSI (7237, 7240, 7250, 7257, 7264, 8741, 9252).

In FY 2007, CDC SI activities will include both short and long term TA in surveillance, IT, HMIS and M&E. CDC will continue support for key SI positions and will maintain support, through clinical partners, for internet connectivity in all EP health districts.

In FY 2004 through FY 2006, the EP scaled up key IT infrastructure in all EP districts. This included procuring and installing IT equipment, and providing internet connectivity for 30 district level facilities through a local contractor. This infrastructure will greatly enhance Rwanda's capacity for program reporting, secure transfer of patient information, and access to national databases (e.g., TRACnet, CNLS database, etc).

CDC will continue to support an epidemiologist on the EP SI Team as the surveillance focal point to provide ongoing TA to TRAC and the NRL for their surveillance activities. FY 2007 surveillance activities will include ANC sentinel surveillance, behavioral surveillance, HIV drug resistance surveillance and HIV incidence testing for surveillance. This support will strengthen national capacity to collect, interpret, and use surveillance data. These activities will complement TRAC's proposed surveillance activities in FY 2007.

CDC will also continue to support an EP HMIS Coordinator to coordinate HMIS activities with the GOR, USG agencies, USG partners, and with multilateral organizations such as the WHO and UNAIDS. The Coordinator, a key member of the USG SI team, will assist GOR in strategic planning for information systems in the health sector and will help strengthen GOR capacity in information systems development, implementation, management and data use to collect critical data for broader HMIS development. The EP HMIS Coordinator will also provide technical support to the MOH to implement the WHO Health Metrics Network assessment tool.

CDC will build epidemiological and research skills for select key staff at MOH institutions. Rwanda has a shortage of trained service providers and academics that has been exacerbated by the 1994 genocide. Three senior staff will be sent to CDC's Field Epidemiology (and Laboratory) Training Program [FE(L)TP]. The FE(L)TP program primarily works with Ministries of Health to build the capacity of key staff to produce data-driven decision making to respond to public health challenges. The program is currently offered in a number of countries including Kenya and South Africa. The objectives of the training would include; strengthening the public health skills and capacity of a cohort of key staff in the MOH, particularly in applied epidemiology; strengthen research and analytic skills of participants; strengthen national surveillance systems; and strengthen laboratory participation in surveillance and field investigation.

CDC will also provide short term TA to support HMIS activities, including design of the HIV case registry, behavioral surveillance, and EP strategic information activities. These funds will also continue to support one local hire position, a data manager at TRAC.

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 sustainable strategic information systems for the national HIV/AIDS program.

Funding for Management and Operations (HVMS): $1,165,000

This activity relates to HVMS (7259). CDC Rwanda requests early funding in the amount of $600,000 to finance the implementation of technical activities in the first quarter of FY 2007. This is a stop-gap measure which will allow CDC to continue its program uninterrupted while awaiting the approval of regular FY 2007 EP funds (CDC functions according to the USG fiscal year, and therefore was required to spend all FY 2006 funds by September 30, 2006). The early funding requested will finance national CT policy revision (to include separate norms and guidelines for PIT and VCT), site surveys for different program areas and purchases of test kits for the MVCT program. Administrative support funds for programmatic activities, including technical staff salaries, considerable international technical assistance costs, equipment and other office costs are included.

In COP06, the 12 LES who comprise the MVCT team were described in narratives but mistakenly excluded from the COP06 staffing matrix. The correction of this error in COP07 makes it appear as if there is a large jump in CDC staff. In actuality, only two new CDC positions are proposed, both LES to be embedded at the Ministry of Education.