AIDS 2012 Abstract - Monitoring quality of HIV clinical services transitioned from international partners to Rwanda Ministry of Health (MOH): clinical performance results 12 months after transition

WEPE630 - Poster Exhibition

Monitoring quality of HIV clinical services transitioned from international partners to Rwanda Ministry of Health (MOH): clinical performance results 12 months after transition

J.P. Nyemazi¹, I. Kankindi², E. Wheeler³, A. Umuhongerwa⁴, F. Kayitesi², J.P. Mfizi², K. Bitamara², C. Biedron³, E. Kayirangwa⁵, B. Chitou⁵, F. Morales⁶, J.R. Morales⁷, V. Mugisha⁸, C. Baribwira⁹, A. Binagwaho², P. Raghunathan⁵

¹Rwanda Biomedical Center, Ministry of Health, Planning and Monitoring and Evaluation, Kigali, Rwanda, ²Rwanda Ministry of Health, Kigali, Rwanda, ³Association of Schools of Public Health Allan Rosenfield Global Health Fellow assigned to Centers for Disease Control and Prevention (CDC), Kigali, Rwanda, ⁴Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda, ⁵Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda, ⁶CTS Global assigned to CDC-Rwanda, Kigali, Rwanda, ⁷Health Resources Services Agency (HRSA), Bethesda, United States, ⁸International Center for AIDS Treatment and Care Programs, Columbia University, Kigali, Rwanda, ⁹University of Maryland Institute of Human Virology, Kigali, Rwanda

Background: US Department of Health and Human Services (HHS) issued a policy to transition HIV clinical services programs funded by President's Emergency Plan for AIDS Relief (PEPFAR) to host-country partners in 2008. From 2009-2012, Rwanda MOH, international partners, HRSA), and CDC coordinated the phased transition of 76 PEPFAR/HHS-funded health facilities from international partners to Rwanda MOH. We collaboratively developed an intensive strategy to monitor HIV program quality during transition. We present HIV clinical performance results from health facilities 12 months after transition to MOH management.
Methods: Rwanda MOH, CDC and partners conducted biannual visits to facilities to monitor HIV clinical services quality at baseline and every 6 months after transition. Performance indicators were verified from routinely collected data. We analyzed baseline, six, and 12-month clinical indicators from 24 transitioned health facilities: % antiretroviral treatment (ART) patients retained in care for 12 months, % ART patients who received CD4 testing six months after treatment initiation, % ART patients who retrieved drugs monthly the previous 12 months. Indicator means were compared using non-parametric Kruskal-Wallis test and generalized estimation equations for longitudinal data.
Results: Mean health facility performance indicators for 12-month ART retention (baseline 89%, 6-months 93%, 12-months 89%, p=0.49) and 6-month CD4 testing (baseline 80%, 6-months 76%, 12-months 87%, p=0.52) did not change significantly 12 months post-transition. Mean health facility performance for ART retrieval fluctuated around baseline (baseline 77%, 6-months 91%, 12-months 76%, p=0.02).
Conclusions: Rwanda MOH was one of the first governments to accept direct responsibility for PEPFAR-supported HIV clinical services. One year post-transition, Rwanda MOH retained ~90% of ART patients in care, and has maintained quality of critical HIV clinical services. Technical assistance from international partners and CDC strengthened MOH clinical monitoring capacity. Continuous monitoring of HIV indicators remains critical to sustain program quality.
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