HIV TREATMENT AND CARE IN THE RWANDAN DEFENSE FORCESAhmed Abajobir, MPH

Country Director

Charles R. Drew University of Medicine and Science

Charles L. Hilliard, Ph.D., Principal Investigator

Funding provided by DoD

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BACKGROUND

• Program Title: HIV Treatment and Care in the Rwandan Defense Forces• Funding Source: DOD/PEPFAR• Fiscal Agent: Charles R. Drew University• Partner: Rwandan Defense Forces (RDF)

– Additional Partners: MOH/RBC, PSI, JHPIEGO• Objectives of the program :

– Support RDF in providing high-quality HIV treatment and care services for military personnel, their families, and communities living around RDF health facilities

– Build capacity within RDF to ensure sustainability of HIV treatment and care programs in Rwanda

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RDF FACILITIES AND PROGRAMS SUPPORTED BY CDU IN RWANDA

Currently, the program supports 10 RDF Health Service outlets:• Six RDF Brigade Clinics:

– Huye – Ngoma – Rucizi– Muhanga– Mukamira– Gicumbi

• Two Military Hospitals:– Rwanda Military Hospital, Kanombe, Kigali– Kaduha Military Hospital, Nhamagabe District

• One Military Medical Rehabilitation Center, Ngarama• One Mobile Care and Treatment Unit (MCTU) that works throughout the

country

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RWANDA-ITS LOCATION IN AFRICA

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LOCATIONS OF CDU SUPPORTED SITES IN RWANDA

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AREAS OF INTERVENTIONS

1. HIV prevention among the RDF and the wider public:A. Awareness raising through Anti-AIDS Clubs (AACs):

– Established and support 11 AACs composed of 575 members including civilians in and around military installations

– Provide technical support to 11 AACs through training on participatory communication methodologies

– Provide audio-visual materials and sound systems to each of the 11 clubs to support community outreach BCC activities

– Provide logistical support (transport and expenses) to AACs for community outreach HIV prevention activities using drama, song and group discussions

– Currently initiating technical and financial support for IGA initiatives to sustain AACs

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AREAS OF INTERVENTION CONT’D

B. Support to VCT services at all RDF health facilities (6 brigade clinics, one Military Rehab Centre and two hospitals)– Support ongoing VCT services at all RDF Health facilities

through provision of regular technical support in the form of training and supervision in HIV/AIDS Counseling and Testing, as well as routine HIV clinical evaluations and psychosocial support

– Support outreach VCT activities to other military installations (e.g. military training centers, as well as communities in the catchment areas of RDF health facilities, including secondary schools)

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AREAS OF INTERVENTIONS CONT’D

C. Support Male Circumcision Program at 6 RDF facilities:• Infrastructure rehabilitation for MC including operating rooms, water systems

and waste disposal systems (incinerators) in five health facilities• Provide infection control training for health service providers from all the RDF

health facilities, as well as for BMOs and RMOs

D. Prevention with Positives:• Established 55 support groups of PLHAs—psychosocial support and positive

living• Trained and mobilized 55 lay counselors to facilitate support groups and provide

peer to peer home based counseling

E. PMTCT:• Provide Technical Support to Health workers: Train based on the national

PMTCT Protocol and provide regular supervision • Monthly nutritional support to 100 mothers and children enrolled in PMTCT

program

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AREAS OF INTERVENTIONS CONT’D

2. Care and treatment for RDF personnel living with HIV/AIDSA. Technical and logistical support to th Mobile Care and Treatment Unit

(MCTU) for HIV+ RDF Personnel deployed in hard-to-reach areas: The services provided include: medical exams, lab tests (including CD4 tests, hematology, Biochemistry), prophylaxis for OIs as well as psychosocial assessment and support.

B. Technical and logistical support for Monthly ARV Drug distribution to RDF soldiers deployed in hard-to-reach areas. This includes travel costs for BMOs and RMOs to collect and distribute drugs to PLHAS in their respective battalions.

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AREAS OF INTERVENTIONS CONT’D

3. Capacity building of RDF health workers through regular on the job training and supportive supervision in the areas of: HBHC, HTXS, HVTB, MTCT, PDCS, PDTX , HVLAB, HVCT and MC.

4. Technical and material support for HIV Program Monitoring and Evaluation (HVM&E) and HIV Program Strategic Information (HIVSI) through training on data collection, management and reporting as well as through provision of IT equipment, personnel and regular supportive supervision.

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AREAS OF INTERVENTIONS CONT’D

5. Financial support for RDF Health facilities (Brigade Clinics and Hospitals)

• Monthly financial support for operational costs of 6 brigade clinics

• Monthly financial support for HIV/AIDS outreach activities at Kaduha Military Hospital and Rwanda Military Hospitals to ensure adherence to ARVs

• Performance Based Financing (PBF) to Rwanda Military Hospital to ensure quality of services through provision of incentives to high performing staff and services

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AREAS OF INTERVENTIONS CONT’D

6. Financial support for human resource development• Salary support for 16 health workers (Nurses, Lab Techs and

Social Workers) at 6 brigade clinics• Salary support for 7 health workers working in the areas of

ART, PMTCT, Laboratory and Data management at Rwanda Military Hospital

• Salary support to 7 health workers working on VCT, Lab, ART, PSS support and laboratory services at Kaduha Military hospital

• Salary support for one physician at Ngarama military rehabilitation center

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AREAS OF INTERVENTIONS CONT’D

7. Infrastructure support• Renovation of infrastructure at Rwanda Military Hospital

(Integrated VCT, ART and PMTCT center as well as laboratory facilities and office space)

• Renovation of six brigade clinics to upgrade them to Health Center levels as per the national MOH standards this includes extension of OR rooms, installing water systems, building incinerators)

• Rehabilitation of laboratory facilities, water systems and waste disposal systems at Kaduha hospital

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AREAS OF INTERVENTIONS CONT’D

8. Provision of Medical and Laboratory Equipment and furniture:• Equipped Rwanda Military Hospital with major laboratory and medical

equipment such as state of the art hematology, biochemistry and other related equipment, ICU equipment, as well as office furniture and high voltage power protectors

• Provided laboratory, medical and office equipment, including CD4 machines, power generators, computers and accessories, and motorcycles to Kaduha Military Hospital

• Equipped 6 brigade clinics with medical and laboratory equipment, as well as furniture and supplies

• Provided laboratory, medical and other supplies, as well as start–up medication supplies to Ngarama rehab center. These include: lab equipment, power generators, computers and accessories, as well as motorcycles

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AREAS OF INTERVENTIONS CONT’D

9. Ongoing Support to Laboratory Accreditation Process At Rwanda Military Hospital:

• Provided Training on Good Laboratory Practices (GLP)• Provided technical support for the development of appropriate

documentation, such as Standard Laboratory Operation Manuals, lab protocols, policies and procedure manual, including development of lab information system—these fulfill requirements necessary for the lab and other services at RMH to be fully accredited.

• As a result of these investments, Rwanda Military Hospital Lab has been evaluated by an accreditation agency and attained 4 star achievement--it is now fully accredited

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ACHIEVEMENTS

• Number of health service outlets supported by DCI with HIV prevention, care and treatment: 10

• Number of health facilities rehabilitated: 8• Number of health facilities provided with medical, laboratory

and office equipment: 9• Number of individuals reached with HIV prevention

messages: 73,570• Number individuals provided HIV testing and counseling:

36,766• Number of individuals enrolled in ART: 3,834

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ACHIEVEMENTS

• Number of pregnant women who received a full package of PMTCT: 5795

• Number of males circumcised: 3,528• Number of individuals trained on Integrated PMTCT,

ART, Ped AIDS HIV/TB management: 232• Number of individuals trained on psychosocial services: 152• Number of AACs formed and currently active: 11• Number of HIV/AIDS support groups formed: 55• Number of HIV/AIDS lay counselors recruited and trained: 55

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SUCCESS STORIES

• Excellent relationship with donors: DOD/PEPFAR• Considered as a model DOD HIV/AIDS program in Africa • Visited by DOD program staff from Angola, Senegal and Ivory

Coast for experience sharing• Excellent relationship with RDF Partners: Our program has

been visited many times by senior RDF leadership, including the Minister of Defense

• Partner protection in the face of funding cuts

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CHALLENGES

• Needs vs. available resources• High turnover of trained health workers• High cost of some services (e.g. Mobile Clinic)• Lack of diversified funding source• Sustainability

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PICTORAL REPRESENTATION

“A PICTURE IS WORTH A THOUSAND WORDS”

Unknown Source

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Partnership

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Infrastructure Rehabilitation--Inaugural of the Integrated HIV/AIDS Treatment and Care Center at Rwanda Military Hospital

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Infrastructure Rehabilitation of RDF Brigade Clinic--Muhanga

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Rucizi Brigade Clinic

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Huye Brigade Clinic

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Rwanda Military Hospital—LabEquipment Support

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Rwanda Military Hospital—LabEquipment Support

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Kaduha Military Hospital--Medical and Lab Equipment Support

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Kaduha Military Hospital--Medical and Lab Equipment Support

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Kaduha Military Hospital--Medical and Lab Equipment Support

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Brigade Clinics--Lab and Medical Equipment

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Brigade Clinics--Lab and Medical Equipment

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Brigade Clinics--Lab and Medical Equipment

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Brigade Clinics--Lab and Medical Equipment

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Brigade Clinics--Lab and Medical Equipment

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HIV Prevention Awareness Raising

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HIV Prevention--Testing

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HIV Prevention--Condom Promotion

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