One-stop TB-HIV services evaluation in Rwanda: comparison of the 2001-2005 and 2006-2010 cohorts.

BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection remains high in Rwanda. Since one-stop TB-HIV services were implemented to manage TB-HIV co-infection, their functioning and impact on TB treatment outcomes have not been assessed. OBJECTIVE: To evaluate one-stop TB-HIV services in Rwanda by comparing the TB treatment outcomes before and after their implementation in Kicukiro and Rulindo districts. METHODS: This descriptive retrospective study used a quantitative questionnaire to determine the functioning of Rwanda's one-stop TB-HIV services. In-depth interviews and focus group discussions with health care providers, heads of facilities and co-infected patients were held to seek their opinion about the functioning of the services. RESULTS: The one-stop TB-HIV services at all 12 health facilities visited were functioning according to the approved criteria. However, TB treatment outcomes after the intervention were not statistically different from those before the intervention. Qualitative data showed a positive impact on the quality of service, particularly a reduction in waiting times and appointments that were better respected as a result of the efficient functioning of the services. CONCLUSION: One-stop TB-HIV services have improved the quality of service in Kicukiro and Rulindo districts. However, the services need to be strengthened programmatically to improve TB treatment outcomes.

Contexte : Une co-infection par la tuberculose (TB) et le virus de l'immunodéficience humaine (VIH) reste fréquente au Rwanda. Depuis que des services TB-VIH à guichet unique ont été mis en œuvre afin de prendre en charge cette co-infection TB-VIH, leur fonctionnement et leur impact sur les résultats du traitement de la TB n'ont pas été évalués.Objectif : Evaluer les services TB-VIH à guichet unique du Rwanda, en comparant les résultats du traitement de la TB avant et après leur mise en œuvre, dans les districts de Kicukiro et Rulindo.Méthodes : Un étude descriptive rétrospective et un questionnaire quantitatif ont permis de connaître le fonctionnement du service TB-VIH à guichet unique ; des entretiens approfondis et des discussions en groupes focaux avec les prestataires de soins, les directeurs des structures et les patients co-infectés ont permis de connaître leur opinion à propos du fonctionnement.Résultats : Après la mise en œuvre des services TB-VIH à guichet unique, les 12 structures de santé visitées fonctionnaient selon les critères établis. Cependant, les résultats du traitement de la TB n'ont pas été significativement différents avant et après l'intervention. Les données qualitatives ont mis en évidence un effet positif de l'intervention sur la qualité de service, notamment sur la réduction du temps d'attente, et sur un meilleur respect des rendez-vous en réponse au bon fonctionnement du service.Conclusion : Les services TB-VIH à guichet unique ont amélioré la qualité des services dans les districts de Kicukiro et Rulindo. Cependant, le service doit être renforcé en termes de programme afin d'améliorer les résultats du traitement de la TB.

Marco de referencia: La frecuencia de coinfección por el bacilo de la tuberculosis (TB) y el virus de la inmunodeficiencia humana (VIH) sigue siendo alta en Rwanda. Desde que se introdujeron los servicios de 'ventanilla única' de atención de la TB y la infección por el VIH con el fin de atender a los pacientes aquejados de coinfección no se ha llevado a cabo una evaluación de su funcionamiento ni de su impacto sobre los desenlaces terapéuticos de la TB.Objetivo: Evaluar los servicios de ventanilla única de atención de la TB y la infección por el VIH en Rwanda, mediante la comparación de los desenlaces del tratamiento antituberculoso antes y después de la introducción de los servicios en los distritos de Kicukiro y Rulindo.Métodos: Fue este un estudio descriptivo retrospectivo, en el cual se administró un cuestionario cuantitativo con el fin de conocer el funcionamiento de los servicios de ventanilla única; se practicaron entrevistas exhaustivas y debates en grupos de opinión dirigidos a los profesionales de salud, los gestores de establecimientos y los pacientes aquejados de coinfección con el objeto de conocer sus opiniones sobre el funcionamiento de los servicios.Resultados: Después de la introducción de los servicios de ventanilla única de atención de la TB y la infección por el VIH, los 12 establecimientos visitados funcionaban de conformidad con los criterios fijados. Sin embargo, los desenlaces del tratamiento antituberculoso después de haber iniciado la intervención no fueron estadísticamente mejores que los resultados anteriores a la misma. Los datos cualitativos pusieron en evidencia un efecto positivo de la intervención sobre la calidad del servicio, sobre todo con respecto al tiempo de espera y al cumplimiento de las citas, como resultado del buen funcionamiento del servicio.Conclusión: El sistema de ventanilla única de atención de la TB y la infección por el VIH ha mejorado la calidad de los servicios prestados en los distritos de Kicukiro y Rulindo. Sin embargo, se precisa un refuerzo programático encaminado a mejorar los desenlaces del tratamiento antituberculoso.

Institutional frameworks for management of epizoonotic emergencies in six countries in the Eastern Africa region: a situational analysis.

INTRODUCTION: The Eastern Africa region is a hot-spot for epidemics of emerging zoonotic diseases ('epizoonotics'). However, the region's capacity for response to epidemics of zoonotic origin has not been documented. This paper presents a multi-country situational analysis on the institutional frameworks for management of zoonotic epidemics in the Eastern Africa region. METHODS: A multi-country assessment of 6 country teams was conducted (Uganda, Kenya, Tanzania, Ethiopia, DRC and Rwanda). It involved a review of records and interviews with key informants from agencies with a stake in the management of zoonotic and disasters in general in the respective countries. Qualitative data were analyzed for key emerging themes. FINDINGS: There are many socio-cultural risk factors to epidemic prone zoonotic diseases in the region. Countries have varying levels of preparedness for zoonotic emergencies. All 6 countries have a framework for disaster management. However, technical response to epidemics is managed by the line sectors, with limited Inter-sectoral collaboration. Some sectors were disproportionately more prepared than others. Surveillance systems are mostly passive and inadequate for early detection. All 6 countries have built reasonable capacity to respond to avian influenza, but not other zoonotic emergencies. Most countries lack personnel at the operational levels, and veterinary public health services are ill-facilitated. CONCLUSION: There is need to strengthen veterinary public health services at all levels, but with a 'one health' approach. There is also need to establish 'risk-based surveillance' hot spots for zoonotic epidemics and to build community resilience 'epizoonotic' diseases.

Prioritization of disasters and their management in Rwanda.

INTRODUCTION: Rwanda has been experiencing quite a significant number of disastrous events of both natural and man-made origin in the last 2 decades. Many cases of disasters are particularly linked to the geographic, historical and socio-cultural aspects of the country. The overall objective of the present article is to perform a situation analysis of disasters in Rwanda and to highlight the institutional and legal framework of disaster management. METHODS: An assessment questionnaire focused on the current capacity, institutional frameworks and on-going initiatives for disaster management at country level and operational level was administered. The assessment was descriptive and used mainly qualitative methods. These included review of records (country policies and policy briefs, programme documents), interviews with key informants from line ministries, and interviews with key informants from stakeholder agencies. RESULTS: The Rwandan hazard profile, its vulnerability and capacity assessment shows top seven disasters which are related to epidemics, hails storms/floods; roads accidents; environmental degradation and earthquakes/volcanic eruption. Currently, the Institutional framework for disaster management and response is coordinated by Ministry of Disaster Management and Refugee Affairs through the Rwanda National Disasters Operation Center. Although disaster risk reduction has been integrated into sustainable policies and plans, most districts do not have adequate capacity to plan for disasters and the majority of districts disaster committees have not yet been trained. CONCLUSION: Rwanda has established a legal and institutional framework for disasters management. There is a need to build capacity in disaster management at operational level (District).

Regional approach to building operational level capacity for disaster planning: the case of the Eastern Africa region.

BACKGROUND: The Eastern Africa region is regularly affected by a variety of disasters ranging from drought, to human conflict and population displacement. The magnitude of emergencies and response capacities is similar across the region. In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams. OBJECTIVES: To develop a sustainable regional approach to building operational level capacity for disaster planning. METHODS: This project was implemented through a higher education leadership initiative. Project activities were spear-headed by a network of Deans and Directors of public health schools within local universities in the Eastern Africa region. The leadership team envisioned a district-oriented systems change strategy. Pre-service and in-service curricula were developed regionally and district teams were formed to attend short training courses. Project activities began with a situational analysis of the disaster management capacity at national and operational levels. The next steps were chronologically the formation of country training teams and training of trainers, the development of a regional disaster management training curriculum and training materials, the cascading of training activities in the region, and the incorporation of emerging issues into the training curriculum. An evaluation model included the analysis of preparedness impact of the training program. RESULTS: The output from the district teams was the creation of individual district-level disaster plans and their implementation. This 4-year project focused on building operational level public health emergency response capacity, which had not previously been part of any national program. Use of the all-hazard approach rather than a scenario-based contingency planning led to the development of a standardized curriculum for training both in-service and pre-service personnel. Materials developed during the implementation phases of the project have been incorporated into public health graduate curricula in the seven schools. This systems-based strategy resulted in demonstrable outcomes related to district preparedness and university engagement in disaster management. CONCLUSION: University partnerships are an effective method to build district-level disaster planning capacity. Use of a regional network created a standardized approach across six countries.