Project Progress report

1. HIV TREATMENT AND CARE IN THE RWANDAN DEFENSE FORCES
Ahmed Abajobir, MPH
Country Director
Charles R. Drew University of Medicine and Science
Charles L. Hilliard, Ph.D., Principal Investigator
Funding provided by DoD
1

2. 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
2

3. 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
3

4. RWANDA-ITS LOCATION IN
AFRICA
4

5. LOCATIONS OF CDU SUPPORTED
SITES IN RWANDA
5

6. 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
6

7. 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)
7

8. 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
8

9. AREAS OF INTERVENTIONS
CONT’D
2. Care and treatment for RDF personnel living with HIV/AIDS
A. 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.
9

10. 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.
10

11. 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
11

12. 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
12

13. 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
13

14. 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
14

15. 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
15

16. 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
16

17. 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
17

18. 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
18

19. 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
19

20. PICTORAL REPRESENTATION
“A PICTURE IS WORTH A THOUSAND WORDS”
Unknown Source
20

21. Partnership
21

22. Infrastructure Rehabilitation--Inaugural of the
Integrated HIV/AIDS Treatment and Care Center at
Rwanda Military Hospital
22

23. Infrastructure Rehabilitation of RDF Brigade
Clinic--Muhanga
23

24. Rucizi Brigade Clinic
24

25. Huye Brigade Clinic
25

26. Rwanda Military Hospital—Lab
Equipment Support
26

27. Rwanda Military Hospital—Lab
Equipment Support
27

28. Kaduha Military Hospital--Medical and
Lab Equipment Support
28

29. Kaduha Military Hospital--Medical and
Lab Equipment Support
29

30. Kaduha Military Hospital--Medical and
Lab Equipment Support
30

31. Brigade Clinics--Lab and Medical
Equipment
31

32. Brigade Clinics--Lab and Medical
Equipment
32

33. Brigade Clinics--Lab and Medical
Equipment
33

34. Brigade Clinics--Lab and Medical
Equipment
34

35. Brigade Clinics--Lab and Medical
Equipment
35

36. HIV Prevention Awareness Raising
36

37. HIV Prevention--Testing
37

38. HIV Prevention--Condom Promotion
38