Rwanda Case study Mugwaneza Placidie, MD, MPH Rwanda Biomedical Centre September 9 - 10, 2020 VIRTUAL FAST-TRACK CITIES 2020 COVID- 19 National Coordination structure Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 COVID- 19 National data Trend, March- 9th September 2020 Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST VIRTUAL Fast - Track Cities Virtual Conference • September 9 • September Conference Cities Virtual Track COVID 19 Data Trend, City of Kigali, March CityofKigali, 19 Data Trend, COVID Daily cases 100 150 200 250 50 0 3/14/2020 3/17/2020 3/22/2020 - 3/26/2020 CITIES TRACK 3/29/2020 04/04/2020 04/08/2020 04/12/2020 4/15/2020 - 4/19/2020 10, 10, 2020 4/23/2020 05/01/2020 2020 05/06/2020 5/26/2020 06/03/2020 06/08/2020 6/13/2020 6/16/2020 6/21/2020 6/24/2020 6/27/2020 Date Date D 6/30/2020 07/03/2020 07/06/2020 07/09/2020 07/12/2020 7/15/2020 7/18/2020 7/21/2020 7/24/2020 7/27/2020 7/30/2020 – 08/02/2020 September 2020 08/05/2020 08/08/2020 08/11/2020 8/14/2020 8/17/2020 8/20/2020 8/21/2020 8/26/2020 8/29/2020 09/01/2020 09/04/2020 0 500 1000 1500 2000 2500 3000 Cumulative cases VIRTUAL FAST-TRACK CITIES 2020 COVID 19 cases_City of Kigali by District 1717 931 786 504 449 354 334 150 115 Gasabo Kicukiro Nyarugenge Female Male Total Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 COVID-19 cases _City of Kigali by Gender Female 39% Male 61% Female Male Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 COVID 19 cases_City of Kigali by Age category 1 80+ 2 12 70 - 79 10 31 60 - 69 22 91 50 - 59 78 195 40 -49 159 501 30 - 39 341 655 20 - 29 305 134 < 20 133 0 100 200 300 400 500 600 700 Male Female Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 COVID-19 management • COVID-19 Testing • Contacts tracing and testing • Mapping of geographic hotspots • Patient management using both health facility and home based models Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 COVID- 19 and Services Delivery Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 HIV services delivery • Prevention measures for COVID 19 1200 • National lockdown mid March 1000 • Restriction of movement 800 • Social distancing 600 • Hand washing 400 200 • HIV preventions services 0 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 • Community HIV testing outreaches targeting Rwanda Cok Key populations and education sessions for New patients starting ART DREAMS beneficiaries • Condoms distribution through social marketing Kigali City, 52941, North, 22252, 6% 13% South, 40321, 10% • Care and treatment services East, 43875, 11% West, 42240, 10% • Delayed drugs refill • Poor adherence due to food insecurity • Delay in ARV shipment Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 Trend of HIV services delivery Patients starting ART HIV Testing and Counseliing 140 14000 120 12000 100 10000 80 8000 60 6000 40 4000 20 2000 0 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 0 Gasabo District Kicukiro District Nyarugenge District Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Gasabo District Kicukiro District Nyarugenge District Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 Strategies to sustain HIV services delivery ▪ National Program - Reinforce Multi month drugs dispensing strategy (drugs for 3 months to unstable patients and 6 months to stable patients) - Development of SOP on HIV services delivery and COVID 19 ▪ Network of people living with HIV - Community follow up of PLHIV using phone call - Putting in place a free line to quickly respond to PLHIV needs - ARV home delivery by peer educators - Identification of people with food insecurity and link with them program ▪ Civil society organizations - Awareness of key populations on COVID- 19 prevention using social media - Identify and support to key populations with adherence issues Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 Trend of TB case notification TB cases notification Jan-March TB cases notification April- 2019 and 2020 June 2019 and 2020 1450 1540 1.9% 1400 1520 12.7% 1500 1350 1480 1300 1460 1250 1440 1200 1420 1150 1400 April-june 2019 April-june 2020 Jan-March 2019 Jan-March 2020 The reduction was mainly observed in big cities Slight reduction on the first quarter because due to non availability of public transport to lockdown started mid March 2020 facilitate movement of patient but the service was available Virtual Fast-Track Cities 2020 • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 Strategies to maintain high quality of TB services ▪ Issue of an Instruction to support treatment adherence by providing one month treatment instead of Direct Observed Treatment ▪ Health facilities advise patient to be treated at community level by CHWs ▪ CHWs helps to collect sputum for bacteriologically follow up of patients ▪ Provision of personal protection equipment to community health workers ▪ Health facilities screen TB for patient screened for COVID- 19 and presenting symptom of TB Virtual Fast-Track Cities 2020 • September 9-10, 2020 14 VIRTUAL FAST-TRACK CITIES 2020 TREND OF UPTAKE OF MATERNAL & CHILD HEALTH SERVICES Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 LESSONS LEARNED Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 Lessons learned for COVID-19 response ▪ High level leadership in COVID- 19 response ▪ National committee of Ministries involved in response chaired by the Prime Minister ▪ Effective communication increased accountability of everyone ▪ Ministry of health’ Daily report on COVID- 19 ▪ National campaigns on COVID-19 preventions #GumaMuRugo”, #NtabeAriNjye” ▪ Media involvement in awareness raising ▪ Engagement of civil society organizations in community mobilization on COVID prevention measures ▪ Effective control of COVID- 19 require multisectoral collaboration and strong partnership ▪ Government ▪ Partners ▪ Civil society organizations ▪ General population ▪ Use of innovative technologies Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 Sustaining high quality of HIV, TB & MCH programs ▪ Quick adaptation of national strategies and services delivery models was instrumental to sustain high quality and the coverage of HIV, TB, MCH services ▪ Close monitoring of key program indicators is essential to inform program on necessary strategies to be implemented ▪ Involvement of community health workers is important to ensure the continuity of services, support and follow up of patients ▪ Involvement of network of people living with HIV and CSO organizations is essential to provide treatment adherence support and addressing of challenges of services beneficiaries. Fast-Track Cities Virtual Conference • September 9-10, 2020 VIRTUAL FAST-TRACK CITIES 2020 Thank you Murakoze Fast-Track Cities Virtual Conference • September 9-10, 2020.