Rwanda HIV Clinical Services Program End-of-Project Report: Achievements and the Way Forward

This month, EGPAF released an end-of-project report for its work in Rwanda on the USAID-funded HIV Clinical Services Program (HCSP). The HCSP aimed to increase access to high-quality, comprehensive HIV-related clinical services, as well as offerings focused on maternal and child health, family planning and reproductive health, nutrition, and sexual and gender-based violence by supporting health institutions as they provide these services. The report, which you can read here, illustrates EGPAF’s achievements and next steps in Rwanda.

From June 2007-December 2012, the Elizabeth Glaser Pediatric AIDS Foundation was the lead clinical partner of the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR) in the Eastern Province of Rwanda under the USAID-funded HIV Clinical Services Program. During the project, EGPAF worked closely with the Rwandan government and supported Rwandan health institutions as they implemented a comprehensive package of integrated HIV clinical care services. Under the HCSP, EGPAF worked closely with the Ministry of Health (MOH), local districts, and health facilities to ensure that programs met national priorities and built the capacity of local staff. Because of EGPAF’s continued efforts with the Rwandan MOH and local governments and health care providers, the project achieved significant results in HIV service delivery.

By September 2012, the program had provided quality HIV clinical services and district capacity building at 48 sites in five districts and Kigali City. Nearly 15,000 clients had received antiretroviral therapy, including 1,129 children, and nearly 32,000 individuals were enrolled in HIV care, including 1,937 children. From 2007 to 2012, the program reached 160,520 women with prevention of mother-to-child transmission (PMTCT) services and offered antiretroviral (ARV) prophylaxis to 7,849 HIV-positive pregnant women and 7,751 HIV-exposed infants. In addition, the program tested 85 percent of men whose partners attended PMTCT services in antenatal care (ANC). An estimated 7,500 HIV-infected pregnant and breastfeeding women and caregivers of HIV-exposed infants were provided with nutritional counseling; food support was given to malnourished HIV-positive pregnant and breastfeeding women; and all HIV-exposed infants were enrolled in the PMTCT program. Using PEPFAR estimations, it is likely that more than 2,000 pediatric HIV infections were averted as a result of these efforts in addition to the many adult lives saved, benefiting thousands of families.

The program also spearheaded significant innovations and best practices, including development of a model for the care for people living with HIV, quality improvement approaches, psychosocial care for children living with HIV, and a maternal and child health (MCH)/HIV integration model.

As the Government of Rwanda is taking more ownership of HIV service delivery, EGPAF is now playing a different role in Rwanda after the end of the HCSP. As a sub-contractor, EGPAF will now be working with the Chemonics-led USAID Rwanda Family Health Project (RFHP), the USAID flagship health service delivery project in Rwanda, which will build on the achievements of the HCSP and continue in supporting the MOH in providing quality care to all Rwandans. The RFHP will focus on increasing the use of district facility-based and community-based family health services. As EGPAF has an important technical role on the RFHP, this project and EGPAF staff will build on their thorough understanding of the gaps in service delivery and focus their attention on continuing the gains made under the HCSP.

In addition, EGPAF/Rwanda has been awarded funding by USAID to conduct a three-year implementation science research project on PMTCT. Under this project, EGPAF and MOH partners will systematically measure breastfeeding practices, treatment adherence, growth, nutrition –
and ultimately, the HIV-free survival of children in Rwanda born to HIV-positive women.

Through these efforts, EGPAF/Rwanda will remain a strong partner to the Rwandan MOH: providing technical assistance, supporting advocacy efforts, and leading the way in implementing research and evaluation.

Cornelia van Zyl is Country Director for Rwanda for the Foundation, based in Rwanda. Lior Miller is Country Officer for Rwanda for the Foundation, based in Los Angeles, CA.