ICAP News - May 2008

Rwanda Rolls Out Integrated ‘One-Stop’ Model for Tuberculosis/HIV Services Nationwide
A ‘one-stop’ model for integrated tuberculosis (TB)/HIV services, pioneered at two ICAP-supported model centers in Rwanda and developed by Rwanda’s National TB Control Program PNLT with ICAP support, is being implemented at healthcare facilities throughout the country to improve access to testing, care, and treatment for both conditions.

TB treatment units serve as the sites for the co-located services where TB patients receive treatment and are offered HIV testing. If found to be HIV infected, patients begin HIV care and treatment in the TB units and continue to receive these services until they have completed TB treatment. At that time, they are accompanied and transferred to the facility’s HIV care and treatment program.

Providing TB and HIV services at a single location for patients with both conditions ensures better coordination of care and reduces the number of appointments patients must make with healthcare providers. The integrated system also limits contact between TB patients and larger numbers of HIV-infected individuals during early periods of TB treatment when co-infected patients may be most infectious.

Since 2005, ICAP has supported the implementation of integrated TB/HIV services at 29 sites in Rwanda. In the first quarter of 2008, nearly all TB patients visiting the facilities received an HIV test. During the same time, 83 percent of HIV-infected TB patients were started on cotrimoxazole therapy as recommended, compared to only 13 percent of patients in 2005.

“The one-stop TB/HIV model is a proven strategy for addressing both conditions in a coordinated and comprehensive way,” said ICAP-Rwanda Deputy Country Director Greet Vandebriel, MD. “We look forward to working with our partners to ensure the successful implementation of integrated services throughout the country.”

For more about ICAP Rwanda, visit here.

Family Care Clinics in Kenya Coordinate Antenatal Care with PMTCT and HIV Services
In support of family-focused HIV services, two ICAP-supported Ministry of Health hospitals in Kenya – Gatundu and Kangundo District Hospitals – have piloted Family Care Clinics for women, their children and partners.

The clinics, which provide in a single location the continuum of services needed by families, are conveniently located adjacent to the hospitals’ maternal-child health departments where pregnant women obtain regular antenatal care and HIV counseling and testing. Women diagnosed with HIV are referred to the Family Care Clinics for prevention of mother-to-child transmission of HIV services and to engage them in HIV care and treatment for their own health. After giving birth, women continue to receive care at the clinics, which also provide post-natal and HIV care for their newborns. Partners of infected women are invited to visit the clinics for HIV counseling testing and, if found to have HIV, are referred to the hospitals’ adult comprehensive HIV care clinics.

“A family-focused approach has proved to be a convenient way for mom and infant to receive antenatal, postnatal, child health and HIV services in the same place at the same time,” said ICAP-Kenya Country Director Mark Hawken, MD. “We are excited to see practical solutions that work and look forward to seeing other facilities adopt this model to improve access to HIV care for mothers and their children.”

Photo caption: A nurse consults with a mother and her newborn at the Family Care Clinic at Gatunda District Hospital.

For more about ICAP Kenya, visit here.

First Regional State Laboratory in Ethiopia Begins DNA PCR Testing Using Dried Blood Spot Method for Early Infant Diagnosis of HIV
As part of the national rollout of Ethiopia’s early infant diagnosis (EID) program, Harari Regional Laboratory, with the support of the Ethiopian Health and Nutrition Research Institute (EHNRI), the U.S. Centers for Disease Control and Prevention (CDC), and ICAP, recently began DNA PCR testing using the Dried Blood Spot (DBS) method. The facility is the first of six regional laboratories in Ethiopia slated to provide this test.

In support of the national EID program, ICAP has been working closely with EHNRI’s National HIV Laboratory – previously the only center with DNA PCR technology for DBS – to initiate EID services throughout the country. ICAP also has supported capacity-building activities at the Harari laboratory and its affiliated healthcare sites, including facility renovations, providing equipment and supplies, and EID trainings for healthcare providers.

The national EID program is a collaborative effort of EHNRI, CDC Ethiopia, ICAP, and other implementing partners of the President’s Emergency Plan for AIDS Relief (PEPFAR). ICAP is the lead pediatrics partner in Ethiopia for PEPFAR.

Photo caption: Laboratory technicians work at the newly renovated Harari Regional Laboratory.

For more about ICAP Ethiopia, visit here.

Initiation of HIV Services at Hospitals Helps Relieve ‘Overwhelming Workload’ on Healthcare System in Nigerian State
Before comprehensive HIV services were initiated at two general hospitals in Akwa Ibom State, Nigeria, many people living with HIV/AIDS had to travel to neighboring states to obtain HIV care and treatment. Akwa Ibom healthcare sites, which are often overwhelmed by large numbers of patients seeking general healthcare services, simply did not have the resources also to meet the needs of patients who sought HIV care and treatment. “The workload here was overwhelming,” recalled State Commissioner for Health Louisa Okpe, MD.

In March, General Hospitals Ikot Ekpene and Etinan initiated comprehensive HIV services following months of intensive support by ICAP, including facility renovations, provision of equipment and supplies, and trainings for healthcare providers and laboratory technicians. ICAP continues to work closely with both hospitals to provide ongoing clinical mentoring and other intensive support.

Recently, Dr. Okpe joined other government officials and community leaders in praising ICAP at separate on-site events marking the start of comprehensive HIV services at the hospitals.

Akwa Ibom has the second highest seroprevalence rate in Nigeria at 8 percent.

In Nigeria, ICAP currently supports 18 sites providing comprehensive HIV services. The sites provide HIV care to more than 22,000 people and antiretroviral therapy to more than 9,600 individuals.

For more about ICAP Nigeria, visit here

ICAP Teams Assess Strategies for ‘Keeping Families Healthy’ at PMTCT and Pediatric HIV Strategic Planning Workshop in South Africa
In mid-April, multidisciplinary teams of ICAP staff from nine country programs came together in Cape Town, South Africa, to critically examine and develop strategies to address the challenges to implementing comprehensive and coordinated prevention of mother-to-child transmission (PMTCT) of HIV and pediatric HIV services.

During the second ICAP Collaborative PMTCT and Pediatric HIV Strategic Planning Workshop, held with the University of Stellenbosch and the South-to-South Partnership for Comprehensive Pediatric HIV/AIDS Care and Treatment, participants reviewed the latest guidelines for PMTCT and pediatric HIV care and treatment. They also shared their own experiences and considered how to address country-specific PMTCT and pediatric HIV program challenges.  

“The workshop provided a terrific forum for staff to share their experiences and learn from one another,” said Elaine Abrams, MD, director of ICAP’s MTCT-Plus Initiative. “It was exciting to have so many professionals devoted specifically to issues related to women and children coming together to focus on keeping families healthy.”

In sessions developed and led by many of the participants themselves, a variety of topics were examined, including how to ensure follow-up of all HIV-exposed infants born to HIV-infected women, providing more efficacious antiretroviral regimens for PMTCT, optimizing PMTCT and maternal health services during labor and delivery, and achievements and challenges in pediatric adherence with treatments.

Participants described the four-day workshop as “inspiring and informative” in showing the “way forward” in facing challenges to care for children, pregnant women, and families.

Photo caption: ICAP-Ethiopia Country Director Zenebe Melaku (left) participates in a small group discussion on knowledge for success: better services through better information.