Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4322
Country/Region: Rwanda
Year: 2007
Main Partner: American Society for Clinical Pathology
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: HHS/CDC
Total Funding: $0

Funding for Care: Adult Care and Support (HBHC): $0

Reprogramming 8/07: THis activity has been abandoned.

This activity relates to activities in HBHC (8188, 8716).

The overall goal of this activity is to build capacity to diagnose a multiplicity of OIs that occur among HIV-infected persons in Rwanda. OI diagnostic equipment will be purchased and laboratory space will be renovated in CHK, the largest public hospital in Rwanda.

OIs among PLWHA are caused by a variety of infectious agents necessitating disparate diagnostic modalities to enable selection of the correct therapeutic response. Unfortunately, the Rwandan health care system is broadly lacking in the kind of laboratory support required to identify responsible infectious agents, and must rely instead upon syndromic diagnosis of OIs, which can be completely inadequate. For example, an HIV-positive person who presents with a seizure might have any number of meningitis infections requiring different diagnostic and therapeutic approaches.

Planned activities under FY 2007 include purchasing bacterial culturing media and incubators, ELISA antigen detection kits, and tissue processing, sectioning and staining equipment. Funding will support two locally hired positions; a laboratory technician and a pathologist to work at CHK. Moreover, funding will provide additional training in the particular equipment upgrades.

This activity reflects the ideas presented in the Rwanda EP five-year strategy and the National Prevention Plan by contributing to the expansion of palliative care provided to HIV/AIDS infected individuals. With new diagnostic knowledge pertaining to OIs and the necessary equipment needed for these diagnoses, the EP will work towards the goal of increasing human resource capacity for palliative care services.

Targets

Target Target Value Not Applicable Number of service outlets providing HIV-related palliative care  supported with performance-base financing Total number of service outlets providing HIV-related palliative care 0  (excluding TB/HIV) Total number of individuals provided with HIV-related palliative care  (excluding TB/HIV) Total number of individuals trained to provide HIV-related palliative 0  care (excluding TB/HIV)

Table 3.3.06:

Funding for Laboratory Infrastructure (HLAB): $0

Reprogramming 8/07: THis activity has been abandoned.

This activity relates to activities in HLAB (7172, 7263).

In FY 2006, the EP begins a partnership with ASCP, building upon FY 2005 activities initiated by CDC and Columbia UTAP in support of KHI. CDC and Columbia renovated and equipped KHI's training laboratory, more than tripling their classroom capacity. ASCP's FY 2006 activities are expected to begin in October 2006. In FY 2007 ASCP will provide TA to KHI to strengthen its laboratory training program. Support will include strategic planning for the laboratory program, support for laboratory curriculum development, direct support for laboratory training for 75 students, and continued infrastructure strengthening. Training activities will place particular emphasis on HIV/AIDS, tuberculosis, and malaria diagnostics. ASCP will continue its laboratory pre-service internship training activity under which KHI lab students are placed at district hospital laboratories to gain field experience in HIV/AIDS-related lab work. KHI is the sole institution in Rwanda that provides pre-service training for laboratory technicians. As such, KHI is a key institution in Rwanda's efforts to provide quality clinical and laboratory services in support of national-scale HIV care and treatment. These activities address the Rwanda EP five-year strategic goal of building sustainable laboratory human capacity.

Funding for Health Systems Strengthening (OHSS): $0

Reprogramming 8/07: This activity has been abandoned.

This activity also relates to HBHC (8139, 8716) and HLAB (7224).

The overall goal of this activity is to support a regional training program for pathologists to better diagnose OIs.

This is a new activity for 2007. The diagnosis of OIs frequently requires the examination of human tissue, either in the form of thin sections or fine needle aspirations. Preparation and examination of such samples requires specialized technical training that is currently unavailable in Rwanda. In the August 2006 meeting, the Association of Pathologists from Eastern, Southern, and Central Africa resolved that the lack of quality OI diagnoses is the major impediment to quality OI treatment. The consensus of this group, which was comprised of about 100 pathologists, is that the most significant challenge to providing accurate OI diagnoses is the lack of trained personnel. No one country has sufficient facilities or senior faculty to provide comprehensive training in Rwanda, Kenya, Tanzania, Malawi, and Uganda, which are all EP focus countries. Collectively, these nations have agreed to each contribute $75,000 towards a joint regional program that could support the training of one MD pathologist and two pathology technicians for each country. These staff members are equally important for their role in obtaining and reading fine needle aspirations from tuberculosis lymphadenitis among PLWHA.

In FY 2007, this activity will train one pathologist and two pathology technicians to identify and properly diagnose OIs in the laboratory. Currently, Rwanda has only 2 pathologists. Each of them does approximately 450 exams per year; in comparison, each pathologist does about 4,000 exams in the US. This activity, therefore, will work towards increasing skill levels in the overall health system and will address the acute shortage of pathologists. Trainees will rotate through clinical centers in Eastern and Central Africa and the training will emphasize the diagnosis of HIV-related diseases.

The direct output of this activity is the training of one pathologist and two lab technicians with the goal of improving the quality of pathology services in Rwanda.

This activity reflects the ideas presented in the Rwanda EP five-year strategy and the National Prevention Plan by strengthening human resource capacity.

Targets

Target Target Value Not Applicable Number of local organizations provided with technical assistance for  HIV-related policy development Number of local organizations provided with technical assistance for 0  HIV-related institutional capacity building Number of individuals trained in HIV-related policy development  Number of individuals trained in HIV-related institutional capacity 0  building Number of individuals trained in HIV-related stigma and  discrimination reduction Number of individuals trained in HIV-related community  mobilization for prevention, care and/or treatment

Table 3.3.14: