AWA Experts 2015 Meeting_eMTCT Best Bractices Presentation Rwanda
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The document summarizes best practices in Rwanda's PMTCT (prevention of mother-to-child transmission) program. It discusses bottlenecks identified in the program's review, including lack of integration and coordination. Strategies to address these included creating a single coordinating body, decentralizing planning, and integrating PMTCT services into maternal and child health platforms. These changes led to successes like improved coverage, but challenges remain around multi-sector engagement and decentralization. Lessons include the importance of community involvement, public-private partnerships, and performance-based financing to motivate health workers.
AWA Experts 2015 Meeting_eMTCT Best Bractices Presentation Rwanda
- 1. Best Practices in Rwanda PMTCT Program Dr Brenda Asiimwe-Kateera Rwanda
- 2. Outline of Presentation âą Background âą PMTCT program review and bottlenecks âą Strategies and Structure âą Successes and Challenges âą Sustainability and Replication âą Lessons Learned
- 3. âą National HIV prevalence has been stable at 3% since 2005 âą HIV prevalence among pregnant women is 3.3% âą 10,000 HIV positive pregnant women are expected to access PMTCT services annually 0 1 2 3 4 5 6 7 8 9 15-19 20-24 25-29 30-34 35-39 40-44 45-49 PercentHIVpositive Women Men HIV Prevalence by Sex HIV Prevalence by Age Source: RDHS 2005 & RDHS 2010 Source: RDHS 2010 Rwanda HIV Epidemiological situationRwanda HIV Epidemiological situation
- 4. National PMTCT Program Milestones 1999-2015 PMTCT pilot âą National PMTCT program (sd-NVP) âą Initial sites expansion âą More Efficacious ARV introduced âą ART program decentralized âą EID pilot âą Transition to More Efficacious Regimens âą Decentralization of CD4 count 1999 - 2000 2001-2004 2005-2006 2007-2008 2009- 2010 âą Task-shifting policy âą Option B PMTCT regimen in Nov 15th 2010 âą eMTCT goal in NSP 2011- 2015 âą Launching of eMTCT by First Lady âą eMTCT strategy and action plan âą Option B+ in 2011 âą PMTCT program 6-week Impact study
- 5. Emergency Response to HIV In 2001, HIV programs coordinated by two bodies â Necessary for the emergency response to the epidemic â PNLS , CNLS (NACC) for policy, resource mobilization and HIV awareness â TRAC for guideline development and implementation of biomedical HIV interventions. In 2010/2011 HIV and AIDS response was reviewed: â CNLS and TRAC coordination functions â Implementation of PMTCT program
- 6. Finding of the review and solutions CNLS and TRAC Functions âą Great response to HIV emergency & high scale-up of HIV services including PMTCT âą Coordination bottlenecks â Duplication of efforts in coordination and inefficiency â limited ownership at sub-national levels Solution to the bottlenecks 1. Having one coordinating board 2. Decentralized planning and implementation These solutions called for âEffective Leadership in Planning and Implementation of PMTCT programsâ HIV Overview in Rwanda
- 7. Findings of the review and solutions PMTCT Programme Implementation âą Good coverage but gaps in: â HIV testing among pregnant women and their male partners of at least 31% â ARV for PMTCT among HIV positive pregnant women of 24% â ARV prophylaxis among exposed infants of 22% âą Implementation bottlenecks â Inadequate integration of PMTCT services in the MNCH services â Unavailability of routine offer of PMTCT services in the private sector Solution to the bottlenecks Integration of PMTCT service at different levels: âąNational planning process including private sector âąMNCH platform âąCommunity These solutions enabled âAchieving Universal Access to Integrated PMTCT servicesâ HIV Overview in Rwanda
- 8. BP 1: Effective Leadership in Planning and Implementation of PMTCT programs Strategy 1: âąCreation of Rwanda Biomedical Center (RBC) under the Ministry of Health. âąParliament endorsement of RBC âąInclusion of RBC as coordination body into national policy and strategic documents âą HIV division within RBC mandated to: â coordinates policy and strategy development, implementation of HIV programs â oversees multi-sectoral response
- 9. BP 1: Effective Leadership in Planning and Implementation of PMTCT programs Strategy 2: âąEngagement of districts teams on their eMTCT data. â Led to development of district specific eMTCT operational plans including district capacity building plan â National level support for quality data analysis and use for improvement of services delivery. âąCreation of District coordination structures â District health management unit under the leadership of the vice mayor of social affairs coordinates HIV activities â The district hospital health team was mandated to provide PMTCT technical support to the health centers.
- 10. BP 1: Effective Leadership in Planning and Implementation of PMTCT programs Strategy 3: âąTask shifting was introduced and nurses were trained on ART initiation âąCollaboration between health centers and community health workers strengthened. âąIntroduction of performance based financing (PBF) mechanisms linked to PMTCT was a motivation for the staff to achieve targets
- 11. Successes âą Creation of RBC has resulted in better coordination, resource mobilization and technical support from the different programmes âą Decentralization and better coordination of eMTCT services has led to development of district specific eMTCT plans âą Managers have been empowered to collaborate with development partners at district level and to leverage resources in support of action plans.
- 12. Successes and Challenges Successes: âą Capacity building of health care workers and PBF has resulted into a more motivated and efficient health care workers at the health facility and community level Challenges: âą Effective multi-sectoral response to HIV â There is a need for greater participation of representatives from other sectors in the HIV response âą Ensuring available of technical support at decentralized levels.
- 13. BP 2: Achieving Universal Access to Integrated PMTCT services Strategy 1: Integration at National level âImprovement of infrastructure of MNCH, equipment and human resources â Creation of Public-Private partnerships Service delivery level, âIntegration of PMTCT into MNCH platform âEmpowerment of managers to re-organize service delivery at their level and to make decisions on how best to integrate PMTCT services in MNCH âą Creation of a one-stop model for PMTCT and MNCH services
- 14. BP 2: Achieving Universal Access to Integrated PMTCT services âą Community level, â High level advocacy for male involvement to increase couple testing, adherence and retention into PMTCT services
- 15. RBC, IHDPC Report, 2011 510 ART sites (96%) 544 VCT sites (99%) 494 PMTCT sites (96%) Universal access to PMTCT is within reach
- 16. Male involvement in PMTCT
- 17. DECLINING TRENDS IN MTCT RATES AT 6 WEEKS AND 18 MONTHS , RWANDA 2006-2014 1. 81.6
- 18. Challenges and Solutions âą Despite the gains made in the Rwanda PMTCT program, challenges such as â Reaching out to women not accessing services are some of the barriers that need to be addressed for the country to go an extra mile towards eMTCT targets â loss to follow-up of mother-infant pairs within the continuum of care âą Implementation of innovative and effective strategies are needed â use of technology such as mobile phones for tracking and tracing of clients. Rwanda is currently facilitating timely transfer of EID results from laboratory to the health facilities using text messages â establishing effective linkages between health facility and community based services are being considered. 18
- 19. Lessons learnt âą Successful integration of PMTCT program within MNCH platform is dependent of a health system that has demonstrated the capacity to deliver high coverage (over 90%) of child survival interventions such as antenatal care and immunization. âą The management at the facility level have a critical role in determine how to re-organisation service delivery to foster integration â Integration of services differs according to the level of health facility and availability of resources. âą Community engagement is critical in ensuring PMTCT is integrated within the community health care system
- 20. Lessons learnt âą Public-private partnerships is critical to achieving universal access to PMTCT service âą The comparative advantage of a sector to deliver services without losing the multi-sectorial aspect of the response is critical in deciding which sector should lead on HIV/AIDS response. âą Decentralized planning and implementation is key to program ownership and in addressing challenges of equitable access and quality of services. âą Male involvement is an entry point for increased couple testing and disclosure of HIV results. âą Performance based financing could be a more cost-effective strategy to address human resource challenges.
- 21. Replicability âą Countries should decide which sector to take the lead in coordination of the HIV response without losing the aspect of multi-sectorial approach to responding to HIV and AIDS âą Decentralized planning and coordination is easily replicable by leveraging the existing administrative structures âą Task shifting and PBF linked to PMTCT indicators would be a proposed solution to human resource constraints as opposed to voluntarism.
- 22. Conclusion âą Delivery of high impact comprehensive eMTCT interventions through a well-coordinated decentralized system has enabled Rwanda to achieve high coverage of eMTCT services and low MTCT rates. âą Task shifting and mentorship are key in ensuring access to quality comprehensive eMTCT services. âą PBF linked to set results has been instrumental in keeping health providers motivated to work hard toward achieving desired results and improve the quality of health services. âą In order to achieve universal access, involvement of private sector in PMTCT service delivery is critical. âą Performance of MNCH platform as indicated by other CSD indicators is critical for successful integration of PMTCT services.
- 23. Acknowledgements âą Beneficiaries- pregnant women and partners interviewed âą Service Providers âą Managers at the district level âą eMTCT BP documentation review committee âą UNICEF for financial and logistical support
- 24. Thank you all
Editor's Notes
- #16: With an HIV prevalence of 3% in the general population, Rwanda as a country has achieved a lot. Currently, on a total of 484 public health facilities, 93% provide VCT services, 85% provide PMTCT and 81% provide ART. Based on the new WHO guidelines, by mid 2010, an estimated 79% to 90% of eligible patients were receiving ART. Seventy eight percent (78%) of HIV positive pregnant women received prophylaxis in PMTCT and 84% were tested with their partners. The transmission of HIV from infected mothers to their children (MTCT) is below 5% and there is a plan to eliminate MTCT by 2015. The country is also targeting two million male circumcisions by 2013.
- #18: 1.58% at 6 weeks of age and 1.83% at 18 months of age4