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International Center for AIDS Care and Treatment Programs

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Title: International Center for AIDS Care and Treatment Programs


1
TB/HIV collaborative activities as part of the
package of care in Rwanda
Greet Vandebriel, MD, MPH Kenneth Turinawe, MD,
MPH Oct. 1st,2007 ICAP Annual Meeting, Nairobi
2
ICAP-Rwanda TB/HIV Objectives
  • Provide support to the MOH in improving linkages
    between HIV and TB programs and services
  • Support the MOH (PNILT - TRAC / districts -
    sites) to coordinate planning, implementation and
    monitoring of national integrated TB and HIV
    services

3
TB/HIV Policy
  • PNILT-TRAC stakeholders workshop
  • Representation from TB/HIV programs, governmental
    institutions, partners and international experts
  • Objective discuss TB/HIV integration, make
    decisions and recommendations for a policy
  • Results
  • Policy developed, approved by
  • MOH on Oct. 03, 2005
  • and disseminated
  • National TB/HIV working group
  • established and regular
  • meetings held

4
Revision of Guidelines and Tools
  • TB and HIV technical manual revised to include
    TB/HIV chapter
  • TB training modules developed to include TB/HIV
    sessions
  • TB and HIV recording and reporting tools revised
    to include information on TB/HIV
  • System for ME of TB screening, developed and
    implemented
  • IEC materials developed and distributed

5
TB/HIV Model Centers
6
One Stop Services for TB Patients with HIV
through the TB service
  • HIV Counseling, Testing and CT
  • HIV CT (PIT)
  • Enrollment into care ( or shift HIV file to TB
    service)
  • Venopucture for CD4 count
  • Medical consultation, prescription of CTX, ART
  • Distribution of CTX and ART (shift pharmacy
    tools, follow up of ART and CTX stock cards)
  • AT the end of TB treatment the patient is refered
    and accompanied to the ART clinic for further
    follow up
  • Home visits

7
Intensified TB Case Finding in PLWH
  • ART Clinic
  • TB screening
  • Transfer/Acompany confirmed TB cases to TB Clinic
  • Community Based Testing
  • Home visits to screen Association members and
    families for TB by PE

8
TB/HIV Model Centers training centers
9
From Model Centers to other ICAP Supported Centers
  • One stop service is feasible
  • Rolled out to 10 ICAP supported DH
  • Needs assessment of training
  • Theoretical training in TB and HIV care and
    treatment
  • Practical training for nurses and visits for MD
    to Model Centers organized from April-July, 2007

10
TB/HIV Site support
11
TB/HIV Site Support
  • Specific TB/HIV integration grid checklist
    developed by ICAP/PNILT
  • ICAP TB/HIV team visits ICAP supported facilities
    regularly , jointly with DHT and PNILT
  • Participation in MDT meeting
  • TB/HIV Monitoring and evaluation

12
to Sites Nationwide
  • TB/HIV national WG adopted ICAP model for TB/HIV
    Integration as national model
  • Harmonization of the approach
  • Visits for Clinical Partners (USG, GF) to Model
    centers
  • Theoretical Training of TB nurses
  • Practical Training at Model centers and other
    ICAP sites
  • Joint follow up by PNILT, TRAC, Partners

13
(No Transcript)
14
HIV Counseling, Testing, Care and Treatment in
TB Patients at ICAP Supported Sites
15
TB screening in Newly Enrolled Patients at ICAP
Supported Sites
16
Challenges
  • MOH PNILT TRAC
  • Communication and collaboration between 2
    traditionally vertical programs
  • Difference in approach to site support
  • Harmonization of ME issues between MOH and ICAP
    (URS)
  • Sites
  • Space (counseling room), cross training, work
    load, rotation of staff
  • Effective referrals between TB and HIV programs
    in facilities with TB service but without ART
    clinic
  • Accurate recording and reporting of TB/HIV data
    (TB screening)
  • Diagnostic follow up for TB suspects,
  • Establishing adequate human resources to
    supervise and monitor program outcomes
  • infection control

17
Rwandan recipe for success
  • Government commitment to integrating TB and HIV
    programs and services.
  • Strong TB program and motivated team to support
    continuous TB/HIV training and supervision at
    decentralized district and facility level
  • TB/HIV focal persons within PNILT-TRAC
  • Establishment of 2 model centers and recrutement
    of TB/HIV focal point persons to design,
    implement and assess innovative strategies for
    TB/HIV integration
  • Integration feasible with addition of minor
    resources in the existing system (reorganization
    crucial)
  • Collaboration with other teams in ICAP to meet
    TB/HIV targets (care coordination, clinicians,
    ME among others)

18
Way Forward
  • Continue supporting MOH in TB/HIV integration
  • Reinforce participation in the national TB/HIV
    working group to harmonize implementation
    strategies among partners
  • Reinforce scaling up of one-stop services for TB
    patients with HIV at sites nationwide
  • Continue site support (supportive supervision,
    mentoring, quality assessment (SOCs)
  • Continue organization of practical/training
    visits of paterner organisations to ICAP
    supported sites
  • Target All sites will have implemented one stop
    service by the end of 2008

19
Acknowledgements
Supported by PEPFAR
  • PNILT Dr Michel Gasana
  • Mr Gaspard Kabanda
  • TRAC Dr Anita Assimwe
  • Dr Jules Mugabo
  • Columbia University Prof. Wafaa El-Sadr
  • Dr Jessica Justman
  • Dr Simon Tsiouris
  • Dr Ruben Sahabo
  • ICAP-Rw
  • CDC Dr Aliou Ayaba
  • Dr Alyssa Finlay
  • Gisenyi, Kicukiro teams
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