ICAP-supported HIV care and treatment services in Rwanda

38 37 35 34

28 26

14

0

5

10

15

20

25

30

35

40

Total numberof facilities

Care &treatment

TB screeningamong HIV

pts

Early infantdiagnosis

Testing &counseling

HIV testingamong TB pts

PMTCT

Type of activity

Nu

mb

er o

f fa

cili

ties

Source: ICAP Rwanda Site Census, August 2007

Number of ICAP-supported facilities by USG-funded activity, Rwanda

6,561

8,668

10,768

12,685

14,743

17,063

19,106

21,616

24,029

26,827

6,6927,899

8,9839,983

11,03212,349

3,9992,894

3,892

1,656

10,547

2,0223,018

8,3479,353

11,67113,033

7,1405,926

4,873

0

5,000

10,000

15,000

20,000

25,000

30,000

July-Sep2004

Oct-Dec2004

Jan-Mar2005

Apr-Jun2005

July-Sep2005

Oct-Dec2005

Jan-Mar2006

Apr-Jun2006

Jul-Sep2006

Oct-Dec2006

Jan-Mar2007

Apr-Jun2007

Nu

mb

er o

f p

atie

nts

Cumulative enrollment in HIV care (pre-ART and ART) & ART care at ICAP-supported facilities, July 2004 – June 2007

HIV care (pre-ART & ART)

ART care

ART patients retained*

Source: ICAP URS, July 2007*Includes ART patients who are not known to have died, transferred or lost to follow-up.

715

894

1,088

1,251

1,405

1,621

1,836

2,157

2,628

2,842

328433 495

647717

802

1,1561,276

692794

928

1,1191,221

349537

237185

962

161

0

500

1,000

1,500

2,000

2,500

3,000

July-Sep2004

Oct-Dec2004

Jan-Mar2005

Apr-Jun2005

July-Sep2005

Oct-Dec2005

Jan-Mar2006

Apr-Jun2006

Jul-Sep2006

Oct-Dec2006

Jan-Mar2007

Apr-Jun2007

Nu

mb

er o

f p

atie

nts

Cumulative pediatric enrollment in HIV care (pre-ART and ART) & ART care at ICAP-supported facilities, July 2004 – June 2007

HIV care (pre-ART & ART)

ART care

ART patients retained*

Source: ICAP URS, July 2007*Includes ART patients who are not known to have died, transferred or lost to follow-up.

Number of ICAP-supported care and treatment facilities reporting, July 2004 – June 2007

3435

8

1113

29272726

18

2

4

0

5

10

15

20

25

30

35

40

Jul-Sep2004

Oct-Dec2004

Jan-Mar2005

Apr-Jun2005

Jul-Sep2005

Oct-Dec2005

Jan-Mar2006

Apr-Jun2006

Jul-Sep2006

Oct-Dec2006

Jan-Mar2007

Apr-Jun2007

Nu

mb

er

of

facil

itie

s

Source: ICAP URS, July 2007

1

5

23

4

2

0

5

10

15

20

25

0% 1-5% 6-10% 11-99% 100%

Percentage of pediatric patients among all HIV care patients

Nu

mb

er

of

facil

itie

sPediatric (<15) enrollment in HIV care (% of total patients) at

ICAP-supported facilities as of June 2007


Target HIV care enrollment to February 2008 and actual enrollment at ICAP-supported facilities as of June 2007

32,245

14,13813,033

26,827

0

10,000

20,000

30,000

40,000

50,000

HIV care ART

Nu

mb

er o

f p

atie

nts

Target enrollment Actual enrollment

Source: ICAP Rwanda Site Census, August 2007

28% 30%

61% 60%60%

29%

11% 10% 11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre-ART ART All patients

Nu

mb

er o

f p

atie

nts

Women 15+ Men 15+ Children <15

Cumulative enrollment in pre-ART and ART care by age and sex at ICAP-supported facilities as of June 2007

(Total in care = 26,827)

n=26,827 n=13,033 n=13,794


33%

16%

15%

35%24%

8% 5%2%

25%

44%

47%

46%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre-ART ART All patients

Nu

mb

er o

f p

atie

nts

Ages 0-1 Ages 2-4 Ages 5-14 Unknown

Cumulative pediatric (<15) enrollment in pre-ART and ART care by age at ICAP-supported facilities, June 2007

(Total in care = 2,842)

n=2,842 n=1,276 n=1,566


ART regimens at ICAP-supported facilities by age, April-June 2007

Adults 15+ (%)n=9,258

Children <15 (%)n=1,056

1st line regimen

d4T-3TC-NVP3,775(41%)

317(30%)

d4T-3TC-EFV595(6%)

88(8%)

ZDV-3TC-NVP2,258(24%)

236(22%)

ZDV-3TC-EFV750(8%)

91(9%)

2nd line regimen129(1%)

5(0%)

Unknown1,751(19%)

319(30%)


Percentage of patients with CD4 counts at baseline, 6 and 12 months after ART initiation over time at ICAP-supported facilities to June 2007*

87%

93%

99% 99%

52%

70% 70%73%

29%

49% 49%

55%

0%

20%

40%

60%

80%

100%

July-Sep 06 Oct-Dec 06 Jan- March 07 Apr-Jun 2007

Baseline 6 months 12 months

*CD4 data are for a subset of patients


n=1,087n=892n=888Number of patients

at baseline

n=na

Average median CD4 count (cells/µL) after 6 and12 months of ART over time at ICAP-supported sites to June 2007*

151

191177

185

259268

280

325

249

278286

326

0

50

100

150

200

250

300

350

July-Sep 06 Oct-Dec 06 Jan-March 07 Apr-Jun 07

CD

4 ce

ll c

ou

nt

incr

ease

at

6 an

d 1

2 m

on

ths

Baseline 6 months 12 months

Number of patients at baseline n=1,087n=892n=888n=na

Source: ICAP URS, July 2007*CD4 data are for a subset of patients initiating ART

Number of patients at baseline n=na

Discontinued 765, 6%

Continued ART 12,268

94%

LTF 13%

Dead 76%

Stopped ART 11%

46 per 1,000 person-years



Unknown <1%<1 per 1,000 person-years


*Does not include patients who transferred out

Reasons for ART discontinuation at ICAP-supported sites as of June 2007*

Program and Facility Characteristics Tracking System

(P-FaCTS)

On-site services at ICAP-supported care and treatment facilities*, Rwanda (n=32 of 35)

0

5

10

15

20

25

30

PMTCT VCT TB Labor anddelivery

ARTpharmacy

On

-sit

e p

rog

ram

av

ail

ab

ilit

y

5 services 69%

n=28/32 n=30/32 n=28/32n=25/32 n=29/32

4 services 13%

1 service 3%2 services 6%

3 services 9%

Source ICAP Rwanda P-FaCTS, January 2007

*Includes data from 32 of 35 facilities (91%) for which a P-FaCTS assessment has been completed

Patient support services at ICAP-supported care and treatment facilities*, Rwanda (n=32 of 35)

0

5

10

15

20

25

30

Adherencesupport

Foodsupport for

adults

Foodsupport for

infants

Peereducatorprogram

Outreach

On

-sit

e p

rog

ram

av

ail

ab

ilit

y

3 services 28%

n=32/32 n=7/32 n=28/32

2 services 53%

n=4/32 n=6/32

1 service 10%4 services

6%

5 services 3%



Median number of staff per 1000 patients on ART at ICAP-supported care and treatment facilities in Rwanda by cadre* (n=32 of 35)

2.9

1.0

24.2

10.8

0

5

10

15

20

25

30

Med

ian

nu

mb

er

of

pro

vid

ers

per

1000 p

ati

en

ts o

n A

RT



PMTCT services

Pregnant women counseled and tested in ANC atICAP/CU-supported PMTCT facilities,

April-June 2007100%

93%

100%

6% 7%

100% (33,648)100% (3,604)

92%

0%

20%

40%

60%

80%

100%

Rwanda Total ICAP

1st ANC Counseled Tested Seroprevalence

HIV-infected pregnant women receiving ART prophylaxis* in ANC at ICAP-supported PMTCT facilities,

April-June 2007

11%22%

78%

24%

11%

1%

53%

0%

20%

40%

60%

80%

100%

Rwanda Total

Wo

men

rec

eivi

ng

AR

T p

rop

hyl

axis

sd-NVP AZT + sd-NVP HAART no prophylaxis

*Maternal ART prophylaxis includes: sd-NVP, AZT/sd-NVP, AZT/sd-NVP + 3TC/AZT tail, and HAART at 34 weeks

Women and infants receiving ART prophylaxis* in maternity at ICAP/CU-supported PMTCT facilities,

April-June 2007

172

1,447

300

1,146

164

1,064

0

500

1,000

1,500

Rwanda Total

Nu

mb

er o

f p

atie

nts

HIV+ women (known/tested in maternity) Women receiving ART prophylaxis

Infants receiving ART prophylaxis

*Maternal ART prophylaxis includes: sd-NVP, AZT/sd-NVP, AZT/sd-NVP + 3TC/AZT tail, and HAART at 34 weeks

TB/HIV services

1,369

2,290

1,841 (80%)

1,012 (74%)

484 (26%)

325 (32%)

48 (10%)*

0

500

1,000

1,500

2,000

2,500

Jan-Mar '07 Apr-Jun '07

Nu

mb

er o

f p

atie

nts

New HIV patients Screened Screened positive Diagnosed/Initiated TB treatment

Screening and treatment for active TB among HIV positive persons enrolled in ICAP-supported care and treatment facilities, Rwanda

Source: ICAP, URS, January-June 2007

* Sites with missing numerators/denominators were excluded

NA

27

site

s

35

site

s

ICAP-supported HIV care and treatment services in Rwanda

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