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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