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
2ICAP-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
3TB/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
4Revision 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
5TB/HIV Model Centers
6One 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
7Intensified 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
8TB/HIV Model Centers training centers
9From 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
10TB/HIV Site support
11TB/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)
14HIV Counseling, Testing, Care and Treatment in
TB Patients at ICAP Supported Sites
15TB screening in Newly Enrolled Patients at ICAP
Supported Sites
16Challenges
- 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
17Rwandan 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)
18Way 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
19Acknowledgements
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