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Rwanda "Family Package" Project

Background
The impact of AIDS on children and families in sub-Saharan Africa is unprecedented. Over 500,000 infants were born with HIV last year alone, and more than one million children are estimated to be living with AIDS. Governments across Africa, in partnership with donors and NGOs have taken important steps to prevent mother-to-child transmission (MTCT) of HIV through programs offering limited access to antiretroviral drugs to pregnant women and their babies. While these efforts have saved many babies from becoming HIV+, they have lacked the resources needed to provide even basic care and treatment to HIV+ mothers, fathers, and their children once babies are born. To promote healthy child development and to prevent premature orphanhood, care and support for HIV+ parents is essential.

The Rwanda Family Package Project
The Family Package Project has been developed [under the auspices of Madame Kagame, the First Lady of Rwanda], to build on the benefits of MTCT interventions by extending basic care and support to HIV+ parents and their children. The Family Package is the next logical step in improving quality of life, promoting family stability, and protecting vulnerable children. In partnership with the International AIDS Trust, USAID, CDC, and in-country NGOs, this project will offer:

Expanded Clinic Services [Phase I]
Basic care including diagnosis and treatment of opportunistic infections (OIs) and sexually transmitted diseases (STDs), tuberculosis (TB) screening and treatment, and malaria prophylaxis and treatment;

Training and support for health care providers and community workers to assist them in providing the range of basic care described above, with clinical back-up, consultation, and referral to a hospital for complex cases;

Training and support for families to provide care at home including palliative care, basic nutrition services, fluid management, skin care, and pain management;

Laboratory capacity will be expanded to address basic tests, and support the collection and transportation of other specimens to a referral hospital or state lab;

On-site pharmacy capability will be expanded to cover the medications needed for treatment of STDs, OIs, immunizations, and some analgesics. The design and stocking of an essential formulary will be a high priority as part of this project.

Community Support Services [Phase II]
While health services are becoming operational, the project will develop plans for integrating other support services that have been identified as essential for family stability and healthy development including:

Food assistance for those families with urgent and outstanding nutrition needs;

Microfinance to assist mothers/families in maintaining economic self sufficiency as they confront the extraordinary demands of HIV/AIDS;

Psychosocial support to explore ways of addressing the need for counseling and peer support in response to the psychological issues that arise from AIDS stigma, HIV resulting from the conflict, isolation, abandonment, facing death, and orphanhood.

Implementation of the Family Package Project in Rwanda
The Family Package Project will initially be anchored at the Kitchikaru Health Center, one of 6 health clinics in Kigali. Over a recent 14 month period, 2,900 pregnant women were counseled about HIV at Kitchikaru, 2275 received an HIV test, 2093 returned for the results, and 583 were HIV+ (28%). Of these HIV+ women, only 171 husbands accepted testing (30%), 139 of whom were HIV+. Currently, pregnant women who test HIV+ are provided with with a limited antiretroviral MTCT intervention either at Kitchikaru, or at Central Hospital of Kigali (CHK) if the delivery is complicated. However, following delivery, there is little care and support that Kitchikaru can currently make available to its HIV+ parents or their children. As a result of the Family Package Project, Kitchikaru will be able to provide the above delineated list of health care and social services, with back-up support from CHK and linkages to community-based NGOs.

While implementation of the Family Package Project will begin at Kitchikaru, it has the potential for expansion to other health centers/clinics in Kigali as the MTCT effort expands, and to other sites in surrounding communities including Kibuyay, Kibungo, Byumba, and rural Kigali with back up support through their district referral hospitals.

Implications of the Family Package Project beyond Rwanda
Currently, MTCT programs are operating in more than 100 sites in at least 17 countries, most of which are in sub-Saharan Africa. Creating a model to serve HIV+ parents through these existing MTCT program offers an innovative way to begin expanding access to basic care and support, by leveraging an existing system. Such an effort can help keep parents alive and able to care for their children, and deserves to be examined for widespread replication.

[Madame Kagame launched this project in conjunction with the Summit of African First Ladies on Children and HIV/AIDS, held in Kigali on May 20-22nd, in hopes that it will be recommended for action at the UN General Assembly on AIDS in June and on Children in September.]