Using Detainees and Peer Educators in HIV prevention and systematic TB screening: Kigali Central Prison (PCK) Eugenie INGABIRE

PEARL Peer Educator for Adherence Referral and Linkages

Context Over 99,687 patients on ART nationwide (TRAC Plus, 2009) Patient retention and sustained adherence are major challenges in chronic care Peer-Education is an effective approach to psychosocial support and BCC Greater involvement and empowerment of PLWHA is a strategic component for program sustainability Need to identify local opportunities to address human resources challenges Need to promote gradual task shifting

Background and objectives PEPFAR/CDC funded initiative through ICAP-CU in Rwanda, building on the successful experience of the pilot Community Based Testing (CBT) project Aiming at: Enhancing adherence of patients enrolled in HIV/AIDS prevention and care programs through peer education, referral and linkages, in collaboration with associations of people living with HIV/AIDS (PLWHA) and district health teams

A- Adherence support and Linkages between services PEARL Framework Communities /Families A- Adherence support and Linkages between services PMTCT TB/HIV ART VCT/PIT B- Tracing and referral btw FOSA and communities B- Tracing and referral btw FOSA and communities

Basis for PEARL in the Prisons GoR commitment to the best quality of care for all Rwandans, including prisoners RBC/IHDPC (farmer CNLS and TRACPlus) launched HIV services in prisons PEARL showed early success in other health facilities PLWHAs in prisons, like other PLWHAs, need psychosocial support and understanding Being away from their families means they lack the traditional family support More likely to have more self stigmatization and self incrimination as to their HIV status May need even more intense support

Peer Education at PCK Peer Education program is jointly implemented by ICAP-CU in collaboration with MININTER and Muhima DH Since July 2009, 74 prisoners (61 males and 13 females) and 12 prison guards and health care workers trained on peer education for 10 days

Peer Educator’s contribution at PCK Peer educators are assigned to: Sensitize village prisoners within the prison on VCT and other HIV services Education session on Radio (within the prison) on different topics related to health and HIV Refer the patient at the clinic in HIV services Systematic screening for TB and referral for further diagnosis Assist the clinic staff to take blood pressure, temperature

Peer Educator’s contribution at PCK, con’t Appointment system: PE make sure that all clients expected to the clinic respect the appointment (CD4, pharmacy, counseling, consultation, support group, etc.) Tracking and tracing: at a weekly basis, meet with social worker and nurse to share the list of clients missing the appointments and trace them

PCK data: August 2009 – September 2011

Systematic TB screening

TB diagnosis and treatment

HIV testing at PCK

Challenges Systematic assessment of newly coming prisoners for life long treatment like ART, etc. Nutrition support for malnourished patients on ART Prisoner’s background vs. HIV related services (e.g. lower acceptance rate of HIV testing for individuals arrested from the street)

Successes Aware prisoners on HIV status Systematic TB screening and follow-up Strengthen adherence to care and treatment services Positive living Increased enrollment and decreased stigma In prison but free for HIV services

Conclusion The management and administration of the prisons has a very open, sincere and collaborative approach: a positive way to move things forward very quickly Prisoners are a motivated group that is easy to mobilize and mobilize each other in return

Acknowledgements Government of Rwanda Ministry of Health/Muhima District Hospital Ministry of Internal Security/Rwanda Correctional Services RBC/IHDPC PEPFAR/CDC Kigali Central Prison staff and Peer Educators ICAP