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Executive summary on TRAC Plus Achievements 2008

The year 2008 was a very productive year for the Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemic Infectious Diseases (TRAC Plu). The main activities were focused on the management of this new Institution after its creation as the merger of the former Treatment and Research AIDS Centre (TRAC), the National Malaria Control Program (PNILP) and the National Tuberculosis and Leprosy Control Program (PNILT) into one institution; a lot was done to strengthen quality delivery of prevention, care and treatment services for malaria, HIV/AIDS, STIs, TB, and other epidemic infectious diseases.

Looking at the administration and management of the Institution, much was done to ensure the change-management from three institutions towards one integrated Institution. The most important achievement at this level is the establishment of an Integrated Administration & Finance Unit from previously parallel units in the former three disease specific units; the establishment of a harmonized and definitive remuneration system of all TRAC Plus staff (both existing & incoming), and the centralization of internal control policies and procedures of former parallel programs.

Two new Units were also created: the Epidemic Infectious Diseases Unit, and the Surveillance, Bioinformatics and IT Unit. In the same move, the Government of Rwanda appointed members of TRAC Plus’ Board of Directors, to ensure the better management of the Institution. 

As far as Administration and Management are still concerned, Directors of Units hold weekly meetings to discuss the coordination of activities. There are also regular exchanges with Global Fund on proposals writing, coordination of activities by sub-recipients, and budgetary follow-up.  

In regards to disease control and prevention, all the four disease specific units of TRAC Plus registered important achievements. The Unit responsible for controlling HIV, AIDS and STIs, continued to expand services Antiretroviral Therapy, Voluntary Counseling and Testing, and Prevention of Mother-To-Child Transmission, throughout the country. By December 2008, 341 Health Facilities were offering PMTCT services. This means that 56 new Health Facilities started PMTCT activities in 2008. The number of Health Facilities with ART services also increased from 171 to 217 Health Facilities throughout the country. On average, about 1400 new patients were enrolled on Antiretrovirals per month. VCT services were initiated in 63 new health facilities, i.e. an increase from 313 to 374 Voluntary Counseling and Testing sites.

With the support of Global Fund, through the Grants Round 6 and Round 7, HIV, AIDS & STIs Unit also worked towards further decreasing HIV transmission and improving the livelihood of those infected and/or affected by HIV in Rwanda, by extending HIV/AIDS services for universal access. By the end of 2008, this move had allowed to extend services for HIV and AIDS to 80% of all health facilities in Rwanda.

Activities for malaria control in Rwanda in 2008 aimed at strengthening the health system for the prompt and correct treatment using ACTs medicines, the implementation of home-based management of fever, and the vector control through the implementation of Indoor Residual Spraying (IRS). The impact noticed in these programs since 2007 were confirmed in a study by WHO in February 2008.

Considering the achievements in malaria control, Rwanda has already met the Millennium Development Goal related to Malaria (Goal 6/Target 8), which stipulates that by 2015, countries should have halved the incidence of malaria, and the indicator 21 of that specific goal regarding the prevalence and deaths rate associated with malaria. We are also close to meeting the indicator 22 on the use of Long-Lasting Insecticidal Nets (LLINs) in households (Rwanda is at 53.8% vs. 60% stipulated by WHO), but we have already met the percentage required (60%) for the use of Long-Lasting Insecticidal Nets (LLINs) among    children under five and the proportion of women who received two or more doses of Intermittent presumptive Treatment of malaria in pregnancy (IPTP) during their last pregnancy (65%).

The main achievement in the fight against tuberculosis are the increase of the treatment success rate which surpassed the international target of 85% and reached 86.2% for the cohort of new sputum smear-positive cases registered in 2007. The detection of all TB cases decreased slightly, but the number of new smear positive cases rose. This is probably due to the implementation of more sensitive staining method (Ziehl Nelsen) countrywide. Leprosy detection campaigns were organized in 7 districts, and technical support was given to four patient associations that are implementing income generating activities.

The control of other epidemic infectious diseases was also strengthened by the creation of a specific unit responsible for ensuring prompt implementation of prevention strategies and communication of public health information about epidemic infectious diseases.  Though the unit was newly established, it managed to set up emergency preventive measures to ensure surveillance and emergency response capabilities and capacities against the threat of Ebola from neighboring countries, participated actively in the Disaster Management Task Force, and contributed to the establishment of Guidelines and Standard Operational Procedures (SOPs) on emergency preparedness and response for Avian Influenza and Hemorrhagic Fever (Ebola, Marburg diseases), and Epidemics Outbreak management committees at all levels (central, district and sector levels).

In other respects, TRAC Plus carriedout a number of key studies that contributed to the better scientific understanding of the treatment and prevention of infectious diseases in Rwanda. Many of these studies gave important results that were presented in local and international scientific meetings and some publications in national or international scientific journals.

During the coming year, the measures that have been introduced to ensure optimal delivery of quality services in 2008 will be strengthened. And as we are also moving towards the integration in the Rwanda Biomedical Centre, and the Institute for HIV, Disease Prevention and Control, the year 2009 promises to be a year of yet more challenges and expanded workload but we have no doubt that we shall be able to continue to contribute to the promotion and facilitation of measures and   actions taken in respect to the prevention, care, treatment, and research in the fields of HIV AIDS, and STIs, Malaria, Tuberculosis and other Epidemics Infectious diseases.

[more details : TRAC Plus annual Report 2008]

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