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Towards Universal Access for Efficient PMTCT, FHI/Rwanda Experience

Towards Universal Access for Efficient PMTCT, FHI/Rwanda Experience. Presented by Fabienne SHUMBUSHO, MD Family Health International / Rwanda 6th Annual Track 1.0 ART Program Meeting , Washington, August 2008. Outline. Evolution of HIV programs in Rwanda FHI/Rwanda interventions

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Towards Universal Access for Efficient PMTCT, FHI/Rwanda Experience

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  1. Towards Universal Access for Efficient PMTCT, FHI/Rwanda Experience Presented by Fabienne SHUMBUSHO, MD Family Health International / Rwanda 6th Annual Track 1.0 ART Program Meeting, Washington, August 2008

  2. Outline • Evolution of HIV programs in Rwanda • FHI/Rwanda interventions • Results • Challenges • Ways forward

  3. Rwanda, Situation Uganda Surface: 26,338 Km2 Population*: 9.3 millions (2007) Doctors *** : 1/42,000 inhabitants  75% of MDs in the capital Nurses***: 1/3,138 inhabitants Tanzania DRC Sources *: 2008 Epidemic Update, CIDC-Rwanda ** : DHS 2005 *** : 2006 Annual Report, MOH Burundi

  4. HIV/AIDS and Other Epidemics Indicators • HIV prevalence*: 3% in 15-49 years • 7.3% urban vs. 2.2% rural • an estimated 200,000 infected persons • Malaria**: Cause of 40% of consultations in health facilities • TB**: 8,701 new cases in 2006 • 32% and 55% of TB patients are HIV co infected respectively in bascilloscopic and other forms * DHS 2005 ** 2006 annual report, MOH

  5. Number of HIV Services Evolution in Rwanda, 2002 - 2007 • (V)CT: 23  312 HF (70%)* • PMTCT: 33  291 HF (65%) • C & T: 4  171 HF (38%) * N = 446 (405 HCs and 41 hospitals) 2002 2007 Source: 2007 TRAC annual report

  6. PMTCT Program Evolution in Rwanda Approaching universal access More efficient PMTCT regimen introduced VCT & PMTCT scale-up 2001 2002 2003 2004 2005 2006 2007 2008 National policy & guidelines for PMTCT (NVP) 2003-8 ARV treatment scale-up plan Pilot intervention with nurses prescribing ART in rural sites

  7. Sites supported by FHI/Rwanda July 2008: 50 sites with (V)CT 50 sites with PMTCT 31 sites with ART

  8. Services Offered for PMTCT • HIV diagnosis: in ANC, (V)CT services, PIT  rapid tests; one site with PCR/DBS • ART: short course PMTCT and ART • Cotrimoxazole preventive therapy for HIV exposed children and infected patients • Nutritional support • Orientation for RH/FP services

  9. SOME OUTCOMES

  10. PMTCT Clients, 2006 – June 2008 (3.7% of tested men) (65% of tested ♀) (4% of tested ♀) (99.8% of tested ♀) (99% of counselled ♀) 39 sites 41 sites 41 sites

  11. Prophylactic Regimens for PMTCT 2006 June 2008 2007

  12. Prophylactic Regimens for PMTCT 2006 June 2008 2007

  13. Prophylactic Regimens for PMTCT 2006 June 2008 2007

  14. Deliveries in HIV+ Women (94% with ARVs for PMTCT) (92% with ARVs for PMTCT) (92% with ARVs for PMTCT) # of Deliveries:

  15. Preventive Therapy for Infants Exposed to HIV

  16. HIV Testing in Exposed Infants

  17. In summary… • Expansion of PMTCT program, with ~100% coverage in FHI supported districts • Testing of pregnant women and their partners improving • ARVs available for PMTCT in all sites • Efficient ARV PMTCT regimens expanding (41/48 as of August 2008) • Rates of positive serology in tested infants at 9 mo reduced to <10%

  18. However… • ~30% of pregnant women in ART sites are eligible to ART but very limited access to it in Non-ART sites • Early infant diagnosis not available • Unknown rates of intervention success in exposed children • Repeated pregnancies still occur • Many cases of exposure to ARVs

  19. Ways forward • Expand ART sites • Task-shifting • Strengthen integration of RH/FP in HIV services • Early infant diagnosis • Need to evaluate our programs

  20. MURAKOZETHANK YOUMERCI

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