Rwanda VCT Scale-up

Category 1

In 2000, IMPACT/Rwanda launched support for its first VCT project with the Rwandan AIDS Information Center, which was designed to reinforce local capacity in the testing and development of a reference center for district VCT services. Generalized and targeted "Know your status" campaigns led by the CNLS stimulated substantial popular demand for HIV testing. National service standards, training programs, quality assurance mechanisms, and coordination were part of the TRAC-facilitated rapid scale-up and ensured that VCT programs were effective.

Goal of the Practice
  • Reinforce the capacity of health providers to provide HIV counseling and testing services.
  • Improve access to quality HIV counseling and testing services.
  • Offer a minimum package of referral services to persons testing HIV-positive.
Core Components
  • National and community-based prevention programs targeting youth
  • Clinic-based services targeting the general population, pregnant women, PLHA, and highly vulnerable populations
  • Preventive communication and care programs targeting populations at highest risk of infection, including sex workers, long-distance drivers, and associated populations
  • Community-based care and support activities targeting PLHA
  • Behavioral surveillance and direct technical assistance to the national government
Noteworthy Results
  • From 4 VCT centers in 2000, IMPACT scaled-up to support 42 VCT sites by the end of June 2006.
  • Reflecting significant scale-up of services in the country in the last few years, youth in the control and intervention sites were both aware of VCT services in their communities. However, youth in the intervention site were twice more likely to make use of these services than were youth in the control site (p=.002).
  • 240,767 women received pre-test counseling; of 99.9 percent accepting to be tested, 12.7 percent tested positive.
  • 227,760 men received pre-test counseling; of 99.9 percent accepting to be tested, 8.8 percent tested positive.
  • 98.1 percent of women and 98.0 percent of men who were tested received post-test counseling.
Lessons Learned
  • When developing HIV service delivery programs in integrated health facilities, funds should be designated for general facility upgrades to improve such service delivery. Strong advocacy is essential to ensure that donors and host government ministries understand the importance of minimal infrastructural upgrades when implementing HIV service delivery programs.
  • Prevention interventions that include VCT promotion must address environmental constraints that prevent participants from following through with desired behaviors.
  • Without access to quality VCT services, many participants were unable to seek out HIV testing. Mobile VCT services were suggested by many participants as essential, complementary service to those offered by the project.
  • Providing VCT services in locations where high risk populations conduct social or work related activities (i.e. where truck drivers spend the night or where they rest after hour,) was seen as a way to increase acceptance of HIV testing.
  • Support for VCT service delivery should include support for the reinforcement or development of PLHA support associations.
Focus Areas
Counseling and Testing
Prevention
Implemented By
Family Health International / IMPACT Project
Participating Organization
  • Institute for Tropical Medicine
  • Management Sciences for Health
  • Population Services International
  • Program for Appropriate Technology in Health (PATH)
  • University of North Carolina at Chapel Hill
Region
Africa
Country
Rwanda
Environment
Clinic/Health facility
Setting
Other/Non-specified
Target Population
  • Adults (over 18)
  • Adolescents (ages 13-17)
  • General Public
  • Sex Workers (SW)
  • Workforce
  • People Living with HIV (PLWH)
Scope
> 50000
Implementation Years
12/2000 - 01/2006