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Effective Health Care services in response to Pediatric HIV

The Ecumenical Pharmaceutical Network (EPN) believes that with strong health systems, its mission to support and strengthen church health systems promote and provide quality pharmaceutical services is attainable.

In line with its Infectious Diseases’ Strategic area, EPN together with Bureau des Formations Médicales Agréées du Rwanda (BUFMAR), is conducting a project aimed at building the capacity and skills of health care workers in church health facilities in Rwanda, provide patients with effective health care services in the management of pediatric HIV.

The project is being carried out within the health care facilities affiliated to BUFMAR, a drug supply organization, also an EPN member. The project receives generous support from the Bread for the World.

HIV Prevalence data in the different regions of Rwanda

Below are some of the recent activities that were conducted in the beginning of the implementation of this continuing HIV project.

 

Improving the capacity to manage pediatric and adolescents & young people’s (AYP) health

From 5th to 9th August 2019, EPN and BUFMAR, in partnership with Rwanda’s Ministry of Health – Rwanda Biomedical Center (RBC), facilitated a training workshop for Healthcare Workers (HCWs) in Kabgayi, Muhanga District, Rwanda. The workshop was aimed at building and improving the capacity of HCWs working in HIV clinics within church health facilities, on management of pediatric and adolescents & young people’s (AYP) infected with HIV.

The expected training outcome was an increase in knowledge of trained HCWs on adherence to pediatric HIV treatment algorithms and STGs, good dispensing and counseling practices to the parents/guardians, and all other aspects addressed during the training, with respect to management of HIV in pediatrics and AYPs.

Twenty (20) health care workers assigned to HIV clinics in the faith based facilities participating in the project were in attendance. Two (2) Trainer-of Trainers delegated RBC, Sylvie Ingibare and Dr. Lea Muhawenimana as well as 2 project staff from BUFMAR, Egide Muziganyi and Gerald Rubulika and EPN’s program officer Dr. Tracie Muraya facilitated the training.

Some of the charts mounted to aid in one of the training session for healthcare workers

From the training

Various training methods were used including presentations, group discussions and case studies.

Through these, the training capacitated participants on the following areas:

  1. The country’s current statistics on HIV (zoning in on pediatrics and AYPs)
  2. The national 2018 treatment guidelines on HIV (zoning in on pediatric dosing)
  3. Prevention of Mother-to-Child Transmission (PMTCT)
  4. Detection and management of treatment failure
  5. Management of most common opportunistic infections (OIs)
  6. Nutrition in HIV infected pediatrics
  7. AYPs Transition into adolescent-hood and adulthood care
  8. Adolescent-friendly HIV treatment centers

An improvement of participants’ knowledge at the completion of the 5-day workshop was documented, with pre and post-test results indicating an increase from an average of 67% to an average of 84%.

Each participant also developed an action plan on the different activities they would undertake, to improve the identified needs/gaps/challenges, back at their facilities, over the project period.

Building knowledge on HIV treatment among religious leaders

Churches occupy an important social and cultural position in Rwanda. Church leaders are key in the management of church health facilities. These facilities, in turn, provide significantly complement government provision of health services especially in the far flung remote rural areas. Faith based organizations account for approximately 20% of health facilities that manage HIV/AIDS in Africa1, thus constituting crucial players in the provision of various interventions to address the challenge of HIV/AIDS. EPN together with BUFMAR is building their knowledge on HIV treatment.

On 13th August 2019, EPN and BUFMAR held an HIV literacy workshop for religious leaders in Kigali Rwanda. The workshop aimed at:

  1. Imparting knowledge of HIV & AIDS to religious leaders in Rwanda, to build their capacity so as to enable them support the country’s interventions in the HIV Response.
  2. Gaining buy-in from the capacitated religious leaders for their support in advocating to the policy makers towards the success of the project in the BUFMAR-affiliated faith based health care facilities on management of pediatric and adolescents & young people (AYP).

Through the workshop, some of the expected outcomes were;

  1. Increased knowledge of the trained religious leaders in matters HIV&AIDS
  2. The trained religious leaders are capacitated on faith healing in HIV&AIDS
  3. The trained religious leaders agree to support EPN/BUFMAR in the advocacy meeting for policy makers and other stakeholders for the need for their support towards success of the project.

Eight (8) religious leaders from different Christian denominations (including Bishop Manasseh Gahima, the Board chairperson of BUFMAR) were in attendance. Two (2) project staff from BUFMAR, Egide Muziganyi and Gerald Rubulika and EPN’s Tracie Muraya facilitated the workshop.

  1. The training capacitated participants on:
  2. The country’s overall HIV situation
  3. The importance/need for HIV Treatment Literacy for religious leaders program
  4. Factors affecting success of HIV treatment –Treatment Adherence; Stigma & Discrimination
  5. Faith Healing in HIV & AIDS

Mr. Egide Muziganyi, Pharmacist, BUFMAR, gives an overview of HIV statistics in Rwanda

Presentations highlighted on the significant milestones that had been done in addressing and raising awareness of HIV amongst Rwandans. Emphasis was put on the need for the Church to pay attention to and impress sustained behavior change amongst the community.

Different tools/materials were shared with the religious leaders, for their use in building capacity on HIV&AIDS of their colleagues in their different parishes. These include WCC-EHAIA’s Treatment Adherence and Faith Healing in the Context of HIV & AIDS in Africa training manual (English and Kinyarwanda versions), physical copies of the Kenyan National AIDS Control Council’s (NACC’s) HIV Messaging Booklet for Religious Leaders as well as the workshop presentations.

Gaining support from policymakers

On 14th August 2019, EPN and BUFMAR held an advocacy breakfast meeting for policymakers in Kigali Rwanda.

The meeting purposed to advocate to Rwanda’s policymakers and other relevant stakeholders on the need for their support and buy-in towards the success of the project in the BUFMAR-affiliated faith-based health care facilities. The expectation of the meeting was that they would commit to collaborate and/or support in facilitating for solutions addressing the challenges identified from the baseline study and also from feedback provided at the HCWs training.

The participants of the meeting included; the Director-General of Clinical and Public Health Services, Rwanda, Dr. Zuberi Muvunyi (representing the Director-General for Ministry of Health – Rwanda Biomedical Center (MOH-RBC)), the Director-General for BUFMAR, Mr. Ernest Rwagasana, representatives from the country’s supply chain body, Ministry of Health medics, project health facilities’ administrators and delegated 3 religious leaders. Two (2) project staff from BUFMAR, EgideMuziganyi and Gerald Rubulika as well as EPN Program Officer Dr. Tracie Muraya, were also in attendance.

Mr. Ernest Rwagasana, the Director-General of BUFMAR addressing policymakers

From the meeting; Dr. Zuberi Muvunyi acknowledged the project as one that was addressing an area that the Ministry had already marked as one that needed innovative strategies so as to achieve the country’s 95:95:95 HIV targets. He assured the participants of MOH-RBC’s commitment to Public-Private Partnership (PPP) and more importantly, to this particular project.

The faith-based sector was also lauded for the unfailing support to the government efforts especially in addressing the different public health issues. The meeting was also further impressed on the need for continued efforts in capacitating health care workers stationed in such far-flung areas, such as seen in this particular project.

Graph showing the global 90:90:90 progress in children living with HIV in Rwanda

 

Graph showing viral load suppression rate in adolescents living with HIV in Rwanda

The MOH representative charged with public health commodity logistics recognized the significant numbers of pediatrics being enrolled into HIV care through the faith based facilities, as evidenced in the graph below, presented to the panel. He expressed MOH-RBC’s commitment to incorporate BUFMAR in the national quantification exercise for public health commodities such as ARVs and HIV diagnostics, going forward.

Graph showing enrollment of pediatrics into HIV care and treatment (in the faith-based sector) in 2018.

Emphasis was laid on the need for religious leaders to be cognizant of the critical role that they play in addressing the HIV response. In addition to this, they were urged to commit and follow through with the action plans as per their earlier literacy workshop and offer support to the faith based health facilities whenever called upon.