Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3493
Country/Region: Rwanda
Year: 2009
Main Partner: Catholic Relief Services
Main Partner Program: NA
Organizational Type: FBO
Funding Agency: HHS/HRSA
Total Funding: $4,130,009

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $348,152

This is a continuing activity from FY 2008. No narrative required.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12792

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12792 8185.08 HHS/Health Catholic Relief 6303 3493.08 CRS $497,068

Resources Services Supplemental

Services

Administration

8185 8185.07 HHS/Health Catholic Relief 4326 3493.07 Catholic Relief $688,338

Resources Services Services

Services Supplemental

Administration

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $40,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Care: Adult Care and Support (HBHC): $525,782

ACTIVITY UNCHANGED FROM FY 2008:

In FY 2007, CRS/AIDSRelief (AR) began providing basic care and support (BCS; formerly "palliative care")

to 5,300 PLHIV at 14 sites. In FY 2008, AR is expected to provide BCS to 9,534 patients at 19 sites,

including 17 health centers and 2 District Hospitals. On-going FY 2009 BCS services will include WHO

clinical staging and baseline CD4 count for all patients; follow-up CD4 every six months, or every 3 months

for patients with CD4 cell counts < 500; management of OIs, STIs, and other HIV-related illnesses, in

accordance with national clinical guidelines; routine provision of cotrimoxazole (CTX) prophylaxis for eligible

adults, children and HIV-exposed infants, based on national guidelines; basic nutritional counseling and

support; positive living and risk reduction counseling; pain and symptom management; and end-of-life care.

In addition, AR will continue to provide psychosocial counseling, including counseling and referrals for HIV-

positive female victims of domestic violence. To ensure comprehensive services across a continuum, AR

will continue to refer patients enrolled in facility-based care services to community-based BCS services,

including adherence counseling, referral for long-lasting insecticide treated bed-nets (LLINs), spiritual

support, stigma reducing activities, OVC support, IGA activities, and home-based care (HBC) services for

end-of-life care. Through SCMS, AR will provide diagnostic kits, CD4 tests, and other exams for clinical

monitoring, and will work with SCMS for the appropriate storage, stock management, and reporting of all OI

and STI-related commodities.

In FY 2009, AR will expand its services to provide BCS for 9,534 existing patients and an additional 1,950

new patients at 19 existing sites and 1 new site. Expanded services will emphasize quality of care via the

Continuous Quality Improvement program, continuum of care through continued network linkages with

community-based organizations, and sustainability of services through performance based financing (PBF).

Strengthened nutritional services through training and provision of nutritional care will include counseling;

nutritional assessments using anthropometric indicators; management of malnutrition through provision of

micronutrient and multivitamin supplements; and links to Title II food support for clinically eligible PLHIV and

children in line with national nutrition guidelines. AR will also support referrals for all PLHIV and their

families for malaria prevention services, including for the provision of LLITNs, in collaboration with CHAMP,

GFATM, and PMI; and referral of PLHIV and their families to CHAMP CBOs and other community-service

providers for distribution of water purification kits and hygiene health education. Strengthened psychological

and spiritual support services for PLHIV at clinic and community levels will be done through expanded

TRACPlus training in psychological support for all AR-supported health facilities and community-based

providers, including gender-based violence (GBV) counseling, positive living, and counseling on prevention

with positives (PwP).

In addition, the MOH has started implementing a new community health policy in FY 2008. The policy calls

for the election of male and female leaders for every 100 households to lead community health activities,

organize other community volunteers into associations and supervise their activities. With the assumption of

20 community health leaders per each health facility, AR will support 20 facilities to train, equip, and

supervise 400 community health leads. They will also organize periodic meetings to ensure quality and

coverage of community-based HIV services and linkages between communities and facilities. In addition to

these health community leads, AR will also train 137 health care workers. The facility-based case

managers, health community leads, health care workers, and community-based volunteers constitute an

effective system that ensures continuum, coverage and quality of care and support for PLWHA.

In order to ensure a continuum of HIV care, AR, in collaboration with CHAMP, will recruit case managers at

each of the supported sites. These case managers, with training in HIV patient follow-up, will ensure

referrals to care services for pediatric patients identified through PMTCT programs, PLHIV associations,

malnutrition centers, and OVC programs. To do this, the case managers will have planning sessions with

facilities and community-based service providers and OVC services providers for more efficient use of

patient referral slips to ensure timely enrollment in care and treatment for children diagnosed with HIV/AIDS.

Case managers will conduct regular case reviews with other partners included in the referral system to

review the effectiveness of the system, identify challenges and design common strategies to overcome any

barrier to pediatric patients routing between services. In addition, adult patients enrolled in care will be

encouraged to have their children tested and infected persons taken to HIV care and treatment sites.

AR-supported sites will assess individual PLHIV needs, organize monthly clinic-wide case management

meetings to minimize follow-up loss of patients, and provide direct oversight of community volunteers. The

community volunteers will be organized in associations motivated through community PBF based on the

number of patients they assist and quality of services provided. CRS will work with CHAMP to develop

effective referral systems between clinical care providers and psychosocial and livelihood support services,

through the use of patient routing slips for referrals and counter referrals from community to facilities and

vice versa. Depending on the needs of individuals and families, health facilities will refer PLHIV to

community-based HBC services, adherence counseling, spiritual support through church-based programs,

stigma reducing activities, CHAMP-funded OVC support, IGA activities (particularly for PLHIV female- and

child-headed households), legal support services, and community-based pain management and end-of-life

care in line with national palliative care guidelines.

PBF is a major component of the Rwanda PEPFAR strategy for ensuring long-term sustainability and

maximizing performance and quality of services. In coordination with the HIV PBF project, CRS will shift

some of their 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 palliative care 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. District health teams (DHTs) now play a critical role in

the oversight and management of clinical and community service delivery. AR will strengthen the capacity of

two DHTs to coordinate an effective network of palliative care and other HIV/AIDS services. The basic

package of financial and technical support includes staff for oversight and implementation, transportation,

communication, training of providers, and other support to carry out key responsibilities.

Increasing pediatric patient enrollment is a major priority for all PEPFAR clinical partners in FY 2009.

Activity Narrative: Rwanda has few available pediatricians. To expand quality pediatric care, AR will train other clinical

providers, using the innovative model developed in FY 2006 and continuing through FY 2009. AR will

support health facilities to refer HIV-positive children to OVC programming for access to education, medical,

social and legal services. AR will also support sites to identify and support women who may be vulnerable

when disclosing their HIV status to their partner, and include in counseling the role of alcohol in contributing

to high-risk behaviors.

This activity addresses the key legislative areas of gender, wrap around for food, microfinance and other

activities, and stigma and discrimination through increased community participation in care and support of

PLHIV.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12794

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12794 4989.08 HHS/Health Catholic Relief 6303 3493.08 CRS $450,246

Resources Services Supplemental

Services

Administration

7163 4989.07 HHS/Health Catholic Relief 4326 3493.07 Catholic Relief $221,340

Resources Services Services

Services Supplemental

Administration

4989 4989.06 HHS/Health Catholic Relief 3493 3493.06 Catholic Relief $56,300

Resources Services Services

Services Supplemental

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $105,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $1,719,513

THIS IS A CONTINUING ACTIVITY FROM FY 2008, ALREADY APPROVED

New/Continuing Activity: Continuing Activity

Continuing Activity: 12797

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12797 4849.08 HHS/Health Catholic Relief 6303 3493.08 CRS $2,730,500

Resources Services Supplemental

Services

Administration

7161 4849.07 HHS/Health Catholic Relief 4326 3493.07 Catholic Relief $950,011

Resources Services Services

Services Supplemental

Administration

4849 4849.06 HHS/Health Catholic Relief 3493 3493.06 Catholic Relief $471,975

Resources Services Services

Services Supplemental

Administration

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $261,680

ACTIVITY UNCHANGED FROM FY 2008:

AIDSRELIEF (AR) is one of the USG partners providing HIV care and treatment services for HIV-infected

adults and children in Rwanda. As for October 2008, the program has 19 sites in 2 districts. Of these

facilities 19 provide PMTCT, 15 provide ART for adults and for children, and have VCT, PMTCT and ART

(for adults and children) co-located in the same premises. These facilities are located in 2 districts of the 2

provinces of Rwanda. In

FY 2008, AR provided a comprehensive package of basic care and support services to 637 HIV-infected

children and treatment to 385, at 12 sites. This package of services, is provided in collaboration with local

community service providers and includes, co-trimoxazole prophylaxis, nutrition counseling and food

support, insecticide treated nets (ITN) and safe water interventions. In addition, AR provides follow-up

services for HIV-exposed infants who are followed-up and maintained on co-trimoxazole prophylaxis until

confirmation of their HIV status can be obtained. For FY 2009, AR will continue to provide the same

package to 1148 HIV-infected children and HIV-exposed infants and increase treatment services for 689

children at its 12 existing sites.

To address the need to expand diagnosis of HIV in the pediatric population AR will increase testing for

targeted pediatric populations within the catchment area of its existing sites. Using each HIV adult patient

enrolled in care and treatment at AR-supported sites, as an index case, AR will offer HIV-testing for their

partners and children and enroll the infected family member/s into care and treatment services. AR-

supported sites will link with OVC service providers operating in its supported districts to offer HIV testing

services for children, according to national guidelines, and ensure enrollment of HIV-infected children into

care and treatment services. In addition, AR-supported sites will link with malnutrition and TB centers within

their facilities or at specialized sites located in the vicinity to provide HIV testing to all pediatric in- and out-

patients and enroll the infected children into care and treatment services. AR will also work to establish and

strengthen linkages with PLHIV associations in the local network, and the administrative district authorities

and health teams to support activities to increase awareness in communities on issues related to pediatric

HIV to increase pediatric HIV testing and enrollment into care.

At PMTCT sites, enhanced follow-up of mothers and exposed infants will be promoted through support

groups of HIV-infected women based on the mother-to-mother model. In this model, women who

demonstrate steady consultation attendance and good baby care are identified and used to coach new HIV-

positive mothers during pregnancy and after delivery to ensure that both women and their infants access

needed services. During these groups sessions AR will provide ITNs, nutrition counseling, enhancing

family food support through training for improved home gardening and animal breading techniques, and

provide food supplementation to mother infant pairs. This last activity is conducted in collaboration with a

Prime PEPFAR funded Community Partner, the World Food Program (WFP), and the

CRS/ACDIVOCA/World Vision consortium. In addition, AIDSRELIEF-supported sites will provide health

education on safe water and provision of water purification products. HIV-exposed infants identified at

PMTCT sites will be followed in the context of existing MCH services offered at existing AIDSRELIEF sites.

Mother and infant information will be transferred from PMTCT to other MCH programs through the "carte de

liaison" currently in use in Rwanda as a means to transfer relevant HIV information between PMTCT and

MCH programs. Early infant diagnosis services, now available at 5 of AIDSRELIEF supported sites, will be

expanded to increase full coverage of sites by end of FY09. EID will be offered at six weeks of age and at

later ages for symptomatic infants less than 18 months of age according to the national algorithm.

AIDSRELIEF will also work with the district health teams to ensure that samples collected at the sites are

transferred efficiently to the processing lab at the National Reference Laboratory in Kigali and work with the

MOH to increase reliability of result turn-around times.

At AIDSRELIEF-supported sites HIV-infected children will be staged clinically and using CD4 (counts or

percentages as these become available) and eligible infants and children will be enrolled in ART.

AIDSRELIEF will work with other clinical implementing partners and the MOH to train health care providers

on newly updated pediatric HIV treatment guidelines which include changes for early treatment of HIV-

infected infants and changes in CD4 thresholds for treatment initiation of children between 36 and 59

months of age. Systematic chart reviews to identify children now eligible for treatment based on new CD4

cut-offs will be initiated in FY 2008.

All pediatric patients will have regular anthropometric evaluations to identify early signs of malnutrition and

ensure prompt initiation of nutrition rehabilitation interventions. Newly identified patients will be screened at

enrollment and at regular intervals for signs and symptoms of common opportunistic infections or other

infectious complications of HIV in children, including: candidiasis, pneumonia, malaria, meningitis, and PCP.

In addition, all pediatric patients will be screened for TB at least once every six months. Children suspected

of having TB will be further investigated and put on TB treatment or INH prophylaxis if infection or exposure

is confirmed based on current national guidance. Additionally, infants and children on ART will also be

assessed at each visit for issues related to adverse events, toxicity and adherence to ART. Staff will be

trained to ensure, as much as possible, the early detection of signs of immunologic and clinical failure and

initiation of second line treatment regimens based on national guidance.

Because HIV-exposed, infected and affected children do not have the same level of vulnerability and risk of

death as non-infected or affected population AIDSRELIEF will work to implement a system to assess

vulnerability and will conduct home visits for families with HIV-infected children in order to identify and

manage accordingly those that need special attention.

Pediatric HIV care and treatment programs in Rwanda face many challenges, including the need for

increased numbers of qualified trained pediatric health care providers. AIDSRELIEF will ensure that site-

level providers are trained or receive refresher training session in pediatric HIV patient management,

according to national guidelines. Providers will receive regularly planned in-service trainings and coaching

sessions. In collaboration with AIDSRelief, and TRAC-plus, AIDSRELIEF has dedicated staff to be part of

the national mentoring team, who will provide continued mentoring to clinical staff at AIDSRELIEF

supported sites in addition to national level mentoring. Mentor staff will, in turn, train hospital and health

Activity Narrative: center service providers in pediatric clinical HIV care, palliative care, patient record-keeping, data recording

and use, and quality performance measurement and improvement. AIDSRELIEF will continue to promote

staff retention and motivation at supported sites through innovative ways including continued training for

individual staff skills development and offering continuous technical support to successfully implement a

performance-based financing model of service delivery which provides staff bonus awards to high scoring

sites.

Through work with the Supply Chain Management System (SCMS) and CAMERWA, the national

pharmaceutical warehouse, the district-level pharmacy,, the National Reference Laboratory (NRL) and the

regional laboratory network, AIDSRELIEF will ensure training of health service providers on HIV

opportunistic infections, drug and reagent stock management and distribution, adherence counseling, good

pharmacy record-keeping and data use. AIDSRELIEF will collaborate with health facilities to survey energy

needs for proper operation of laboratories, IT equipment and storage facilities. Sites in need of back-up or

extended power supplies will be equipped with solar-based energy sources.

In FY 2008, AIDSRELIEF has worked closely with CIDC to implement a mentoring program to train health

care providers in adult and pediatric HIV and HIV/TB management. This program will continue in FY 2009

to support the building of capacity at site and district level to provide quality clinical services for children.

510 health care providers from 19 sites at 2 districts will receive training through this mentorship program.

Efforts to rapidly disseminate and begin implementation of new treatment guidelines for infants and children

will be greatly supported through this effort. In addition AIDS Relief will continue to train managers and

health service providers in the use of patient data software. Pediatric HIV care indicators will be linked to

PMTCT indicators in the database for better follow-up of infants exposed to HIV. With improved data on

pediatric HIV care, AIDSRELIEF, in collaboration with CIDC, the national performance-based program, and

the HIVQUAL project will support health facilities to build and sustain a system of quality performance

measurement, improvement. This system will use basic pediatric HIV care and support and treatment data

as a source to regularly review program performance and design/implement appropriate interventions to

improve the quality of services provided to children and their families. AIDSRELIEF staff in charge of each

district will ensure that meetings to review internal data take place on a regular basis and that the

improvement plan is implemented at individual sites. Yearly, district-level meetings are planned where each

facility will share their performance data and improvement strategies. AIDSRELIEF will ensure that pediatric

HIV care is integrated with adult HIV care and that the family approach is reinforced.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12794

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12794 4989.08 HHS/Health Catholic Relief 6303 3493.08 CRS $450,246

Resources Services Supplemental

Services

Administration

7163 4989.07 HHS/Health Catholic Relief 4326 3493.07 Catholic Relief $221,340

Resources Services Services

Services Supplemental

Administration

4989 4989.06 HHS/Health Catholic Relief 3493 3493.06 Catholic Relief $56,300

Resources Services Services

Services Supplemental

Administration

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $261,681

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $255,310

This is a continuing activity from FY 2008. No narrative required.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12797

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12797 4849.08 HHS/Health Catholic Relief 6303 3493.08 CRS $2,730,500

Resources Services Supplemental

Services

Administration

7161 4849.07 HHS/Health Catholic Relief 4326 3493.07 Catholic Relief $950,011

Resources Services Services

Services Supplemental

Administration

4849 4849.06 HHS/Health Catholic Relief 3493 3493.06 Catholic Relief $471,975

Resources Services Services

Services Supplemental

Administration

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $255,311

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $903,521

ACTIVITY UNCHANGED FROM FY 2008.

AIDS Relief's (AR) strategy for TB/HIV is to ensure effective roll out of the one stop service by ensuring that

all clients with HIV infection in Local Partners Treatment Facilities (LPTFs) are routinely screened for TB;

and patients with TB have access to HIV counseling and testing (HCT). Dually infected clients are offered

appropriate care within and outside the LPTF. In FY 2008, AR is supporting 19 LPTFs in 2 provinces: 4

LPTF with PMTCT/VCT services only and 14 with ART. In FY 2009, AR will add one additional site while

assuring complete VCT/PMCT/ART services to a total of 20 LPTFs in Nyamasheke regions/province. In

setting and achieving FY 2009 targets, consideration has been given to modulating AR's rapid FY 2008

scale up plans in order to concomitantly work towards continuous quality improvement.

Screening & treatment targets: During FY 2009 95% of all planned 11,484 HIV positive patients enrolled in

care at AR supported sites will be screened for signs of TB using the "5 questions" for TB screening and

from these an estimated 2% of all screened are expected to be diagnosed and treated for TB. This is based

on FY 2008 figures whereby 9543 patients will be screened for TB and of these, an estimated 130 will be

found to be positive (~1.5%). However, we expect to increase the percentage of those who screen positive

who will be diagnose and treated for TB from 1.5% to 3% in FY 2009 by supporting sites to improve

diagnostic and treatment skills, especially AFB negative patients. Of those found to be positive to any of the

TB screening questions 97% will have sputum AFB done if they can produce sputum. This will be collected

and transported from treatment centers to the TB diagnostic centers or done directly in the diagnostic

centers for others. TB screening of PLWHA that screen positive but cannot produce sputum will be

managed using the practical approach to lung health (PAL) at the district hospitals (DH). A referral/network

linkage system and support between health center (HC) and DH and the community will be enhanced to

ensure an effective running of this activity in collaboration with the Rwandan TB program. This linkage

system includes supporting patient transport for x-ray and care at district hospitals; supporting TB/HIV

nurses by providing tracking tool and a communication system for following up on results of referrals and

care between health centers and hospitals. Trained Community health care providers will also assure

screening at home for TB symptoms among PLHIV and refer suspects to LPTF, conduct home visits to

assure adherence to antiTB medications and ART, and trace family members of PLHIV accessing TB/HIV

services and facilitate their TB screening and appropriate care. All TB patients will be offered HIV

counseling and testing services at both the DH and the HC. Laboratory diagnostic capacity will be upgraded

and human capacity developed to ensure adequate TB diagnosis for PLWHA. Through basic care and

support services all patients with TB disease and HIV infection will be put on cotrimoxazole prophylaxis

therapy (CPT).

TB Infection control: AR will ensure proper patient triage, specimen collection, waste disposal, proper

ventilation and administrative control activities such as active identification of those with TB symptoms,

patient segregation, availability and use of infection control job aids. TB infection prevention and control will

be accomplished using these work practices and administrative measures. Patient and staff education will

be routinely conducted to ensure program success. AR will adopt joint adherence strategies for patients on

ARVs and TB DOTS including treatment preparation sessions and follow-up in community by trained health

care providers. AR will strengthen the facilities' capacity to meet special needs of PLWHA on both ART and

anti-TB treatment assuring cross-training of staff, one-stop service for co-infected, improving communication

between services and providers and facilities. Nosocomial transmission of TB to patients with HIV infection

will be prevented through measures and principles such as basic hygiene (e.g., cough etiquette training),

proper sputum disposal, isolation of known TB cases, and good cross ventilation at clinics.

Patients screened and treated for TB and TB/HIV will be entered into AR updated IQChart patient record

system and regularly submitted in the national TB program reporting tool with appropriate linkages of

medical records between TB and HIV points of service.

Trainings & patient's support: AR will train 44 healthcare workers (HCW) in TB/HIV management at both the

DH and the HC. Twenty medical records staff will be trained on data collection for suspected and diagnosed

TB cases. Four doctors from the two district hospitals, 20 nurses (2 from each FOSA) and twenty

community health worker (CHWs) leaders (one from each FOSA) will be trained on x-ray diagnosis, clinical

management, and care of patients with TB/HIV co-infection which will be complemented by onsite

preceptorships and mentoring to enhance case finding. 640 Community health workers (CHWs), treatment

support specialists, and members of support groups will be trained to screen and refer for TB symptoms,

assist with patient adherence to ART and anti-TB drugs and contact tracing of patients. Trainings will also

be expanded to include TB infection control for both hospital administrators and HCW. All AR TB staff will

be trained/ retrained to enhance TB diagnostic and management skills.

Quality improvement program: In FY 2009, AR will strengthen its program for Continuous Quality

Improvement (CQI) to improve and institutionalize quality interventions. AR CQI specialist who will be

supervised by a the CQI Advisor will be responsible for collaborating with LPTF quality assurance

committees to spearhead CQI activities in TB/HIV care. This will include standardizing patient medical

records to ensure proper record keeping and continuity of care at all LPTFs. AR TB/HIV activities that will

be addressed include program level reporting to enhance the effectiveness and efficiency of both paper

based and computer based Patient Monitoring and Management (PMM) systems using IQ charts and

assuring data quality across all LPTFs.

TB Pathology: AR will continue its TB FNA pathology pilot activities of training, procurement and personnel

support. AR will also expand district level capacity to diagnose extrapulmonary TB using Fine Needle

Aspirate (FNA). Our plans for scaling up include expanding our in country operations by collaborating with

UMSOM-IHV TB/Pathology programs at the National Reference Laboratory (NRL) and the University

Teaching Laboratories of CHUB, CHUK plus regional TB hospitals to increase mentoring and training for

physicians in 2 DH in Nyamasheke. Further plans include establishing the telepathology unit at CHUB

where UMSOM-IHV pathologists will review and compare slides via internet and assist in providing accurate

diagnoses on difficult cases by collaborating with the pathologists in Rwanda. We will support

decentralization of this capacity through implementation and training on the use of radiology equipment with

Activity Narrative: telepathology technology already present in Nyamasheke district hospitals. In turn, the Rwandan

pathologists (supported by UMSOM-IHV) will assist the DH in Nyamasheke by reviewing slides via internet

for improved TB diagnostic ability. AR will hire an additional pathologist to assist in the decentralization and

training efforts.

As part of the clinical mentoring program with TRACPlus/CIDC, we will continue to strengthen the national

TB program through better integration of TB and HIV services at all levels leading to better TB treatment

outcomes. Particularly the focus will be on increasing diagnosis and treatment of TB among PLHIV and

support the national scale out of HIV testing among patients with TB.

AR's team will work with the DH team to conduct formalized site visits at least quarterly during which there

will be evaluations of TB/HIV clinic services, TB laboratory services, infection control practices, utilization of

National tools and guidelines, proper medical record keeping, patient follow-up and referral coordination. On

-site TA/supportive supervision with more frequent follow-up monitoring visits will be provided to address

weaknesses when identified during routine monitoring visits. Each of these activities will highlight

opportunities for improvement of clinical practices.

Sustainability lies at the heart of the AR program with focus on technical, organizational, funding, policy and

advocacy dimensions. Through its comprehensive approach to programming, AR will increase access to

quality care and treatment, while simultaneously strengthening NRL, TRACPlus/CIDC, CHUB, CHUK and

health facility systems. All activities will continue to be implemented in close collaboration with the GOR and

the district health teams to ensure coordination and information sharing, thus promoting long-term

sustainability. Health systems strengthening will include human resource support and management,

financial management, infrastructure improvement, and strengthening of health management information

systems.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16863

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16863 16863.08 HHS/Health Catholic Relief 6303 3493.08 CRS $1,035,891

Resources Services Supplemental

Services

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $450,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Testing: HIV Testing and Counseling (HVCT): $116,051

This is a continuing activity from FY 2008. No narrative required.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12796

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12796 8164.08 HHS/Health Catholic Relief 6303 3493.08 CRS $94,356

Resources Services Supplemental

Services

Administration

8164 8164.07 HHS/Health Catholic Relief 4326 3493.07 Catholic Relief $71,900

Resources Services Services

Services Supplemental

Administration

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Subpartners Total: $0
Bungwe Health Center: NA
Cross Cutting Budget Categories and Known Amounts Total: $1,111,992
Human Resources for Health $40,000
Human Resources for Health $105,000
Human Resources for Health $261,681
Human Resources for Health $255,311
Human Resources for Health $450,000