[VCT/PMTCT][District level] [ARV] [Surveillance]

VCT/PMTCT  

National level: 

 Policy development (Partners: CDC, UNICEF, USAID, WHO)

- Definition of protocols and directives on VCT/PMTCT
- Production of IEC materials
- Coordination of VCT/PMTCT activities
- Permenant secretary of technical working group

 Human resource expansion (Partners: CDC, USAID-EGPAF   and MAP)

- Training of trainers at national level
- Training of trainers at district level
- Recruitment of personnel
- Production of training modules
- Recruitment of trainers
- Coordination of trainings

Supplies

- Provision of materials and tests
- Estimation of needed materials & tests
- Providing reports on materials & tests utilisation
- Request of materials & tests to CAMERWA and Boehringer-Ingelheim & Axios

District level:

Extention of VCT/PMTCT programs with health districts and partners

- Identification of new VCT/PMTCT sites
- Identification of partners
- Needs assessment on the identified sites
- Training of health providers on VCT/PMTCT
- Initiation of VCT program

Integration of PMTC on sites with partners: UNICEF, WHO, USAID

- IEC service
- Antenatal service
- Laboratory
- Delivery service
- Post natal service
- Under five years clinic
- Family planning service.

Follow-up of activities in existing sites (with partners)

Refreshment training on VCT/PMTCT
Provision of material, tests and equipment
Supervision of activities
Report on activities

ARV

Coordination at the national level of all activities related to care for persons living with HIV/AIDS
Organization of clinical treatment of PLWHA, including OI, STI and ARV provision
Coordination for development of norms for clinical treatment of HIV/AIDS
Organization of trainings and continuing education in the HIV/AIDS domain
Conduct monitoring and evaluation of activities related to clinical HIV/AIDS care
Development and revision of guides for clinical care
Orientation of partners in site selection
Coordination and development of research protocols in the HIV/AIDS domain
Research on clinical care for PLWHA
Production of IEC materials for the fight against HIV/AIDS
Initiation of treatment programs at the site level

SURVEILLANCE

Since 2001, the epidemiological surveillance unit of TRAC, with financial and technical support from CDC through the project « Impact Rwanda », has launched a new system of sero-surveillance of HIV among pregnant women seeking antenatal care services at 24 sentinel sites. Two sero-surveillance surveys have been conducted in 2002 and 2003. Included in these surveys were all pregnant women presenting themselves for ANC for the first time during the surveillance period, and agreeing to a blood test for syphilis. The principal activities during the course of these sero-surveillance surveys consisted of :

Training service providers at sentinel sites in epidemiological surveillance of HIV/AIDS

Collecting blood samples: The minimum target sample size for each sentinel site was at least 400 women and the duration of the collection of samples was fixed at 20 weeks. The women meeting the criteria for qualification were enrolled in a survey in consecutive fashion. The drawing of blood and the detection of HIV infection were done according to the anonymous, non-correlated method. During the sampling period, sites were supervised once every two weeks, and samples were transported to the national reference laboratory by a TRAC supervisor. The testing of HIV antibodies was done at the laboratory, with the ELISA test.

The key results of the survey in 2002 were the following :

The rates of seroprevalence varied from 1.2% at a rural site in Butare province to 13% at two sites in Kigali .

The rates of seroprevalence in urban zones were constantly higher than in rural zones. The median rate in urban zones was 6.9%, while the median rate in rural zones was 3.0%.

The rate of seroprevalence among the youngest group surveyed (15-19 years) was high both in rural and urban areas (6.5% and 3.0%, respectively).

In an analysis of trends since 1998 among six sites participating in the sentinel site surveys, two urban sites registered significant drops in seroprevalence. To better monitor the trend of HIV prevalence in sentinel sites, the same sero-surveillance survey was repeated in 2003 (report is under development).

Products and reports