SECTION I: Summary of the proposal direction Remark: the guiding summary will be used to present an overview of the proposal to several members of the Secretariat, the Technical Examination Group and the Committee of the Global Fund. TO BE FILLED IN AFTER THE OTHER SECTIONS ARE FILLED IN General information Table I.a Title of the proposal Decentralisation of for the overall management of people living (The title must with HIV/AIDS convey the scope of (former title: Networked inter-hospital treatment solidarity for the proposal): HIV/AIDS illnesses in Rwanda (ESTHER INITIATIVE) Country or region Rwanda concerned: Applicant name: Rwanda Ministry of Health Groups represented X Government - Ministry of X UN/Multilateral Institution in the GFC Health (indicate the number X Government - Other ministries X Bilateral Institution of members from each category): X NGO/Community Academic/educational Organisations Organisations X Private Sector Religious/faith Groups X People with HIV/TB/malaria* Other (please specify): If the proposal is NOT submitted through a GFC, explain why: Specify which component (s) is/are targeted by this proposal and the amount requested from the Global Fund**: Table I.b Amount requested from the GF per year (in thousands of US dollars) Year 1 Year 2 Year 3 Year 4 Year 5 Total Component(s) X HIV/AIDS 5.760. 9.100. 11.991 13.558 16.235 56.646 465 270 .690 .310 .730 .465 (indicate by a X): TB Malaria HIV/TB Total 5.760. 9.100. 11.991 13.558 16.235 56.64 465 270 .690 .310 .730 6.465 Total of funds from other sources for 13.900 12.600 10.800 N/A N/A activities relating to the proposal .000 .00 .000 Please specify how you wish to see this proposal evaluated** (mark with a cross): The Proposal must be evaluated globally The Proposal must be evaluated as separate components X Brief summary of the proposal (1 page)(please include quantitative data if possible): • Describe the aims, objectives, and general activities by component, including the expected results and the schedule to attain these results: The proposal aims to improve the quality and life expectancy of people with HIV/AIDS while strengthening prevention by a family approach. It will enable access to quality care to be increased, including access to antiretrovirals, by decentralisation of their deliverance and patient monitoring The care system will be centred around 30 health centres, 5 district hospitals and the CHU/CHK as national reference which benefits from an ESTHER twinning with Luxembourg. This management is supported by strengthening psychosocial and nutritional monitoring (6,000 families) via 40 local associations under the new National Network of PLWHIV and via sponsoring and support groups. An initial investment of 9 months in health structures and human resources will prepare the decentralised management phase; enrolment of patients will then be done gradually, up to 50 new patients per month and per district hospital and 100 new patients per month at CHU/CHK level. At programme end, more people will benefit from better management; this will be spread geographically in a more equitable way; family screening will be promoted and will strengthen the prevention actions; the entire population will benefit from the strengthened health structures at every level of the system. • Indicate the beneficiaries of the proposal by component and the advantages to be derived from it (including target populations and an estimate of their number): Management plans a significant coverage of province requirements, in the region of 15 - 30% of affected people, while at the same time pursuing coverage in Kigali via the CHU/CHK, or a total of 19,350 people on ARVs and 50,000 people on prophylaxis and treated for their opportunist infections. It is supplemented by psychosocial and nutritional support (6,000 families) via 40 local associations under the New National System of PLWHIV who will be institutionally supported in their action capacity (training, equipment, operation). The programme medical staff will see their capacity also strengthened, whether it is TRAC (policy making, laboratory quality, SIS, and co-ordination), Camerwa (drug distribution system), district hospitals (more of better trained staff). • If there are several components, describe if appropriate, the expected synergy from the combining of the various components (By synergy, is understood the added value that the various components bring mutually or the manner in which combining components can lower the scope of each component taken individually): Family screening is the nucleus of the proposal: this family “knowledge” limits the factors of stigmatisation detrimental to adhering to the programme, strengthens the support potential of people on ARVs and transforms the Rwanda family into a key entity to widen community based prevention. Strengthening the care offer is a chance to promote this screening; it is coupled with the local raising awareness actions accomplished by the PLWHIV associations to create demand. Treatment and prevention thus strengthen each other. This family aspect is strengthened by an operational research dynamic to improve knowledge of causes of family stigmatisation and to derive from this the tools best suited to alter behaviour. • Indicate whether the proposal is an extension of current measures or the start of new activities. Explain how education and good practices acquired at the time of the preceding phase are integrated into this proposal; and describe the innovative aspects of the proposal. The initial financing instalment from the Global Fund enables the setting up of a nationally integrated VCT (including STD, PMTCT, OI); moreover various pilot projects for treatment management including ARV are pending, in particular to the CHK (reference hospital) and in Kigali. The proposals enables these acquired elements to be capitalised on to extend the management beyond Kigali while strengthening the second level, the district hospitals, to create an integrated care system of national size that currently does not exist.