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

2. PEARL
Peer
Educator for
Adherence
Referral and
Linkages

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. PCK data: August 2009 – September 2011

11. Systematic TB screening

12. TB diagnosis and treatment

13. HIV testing at PCK

14. 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)

15. 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

16. 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

17. 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