2016 Rwanda

All the above photos belong to Sanchari Ghosh and Laura Sirbu

Interprofessional global student project: Assessing clinician compliance with national guidelines for pediatric HIV care and treatment in Rwanda

Summer 2016

Led by David Riedel, MD, MPH, School of Medicine, Institute of Human Virology

Students (school affiliation): Laura Sirbu (medicine) and Sanchari Ghosh (pharmacy)

Project goal

The overall goal of this project was to assess clinical compliance with national guidelines for pediatric patients receiving HIV care and treatment in Rwanda.

Project description

The UMB medical and pharmacy students worked together under the supervision of Dr. Riedel and UMB in-country staff to carry out site visits to UMB-assigned district hospitals and health centers in and around Kigali. They met with providers (nurses, doctors, and pharmacists) at sites to discuss the program and its strengths and weaknesses. Rwanda has been able to roll out their HIV treatment programs quite successfully and are now looking at similar models to use in approaching care and treatment for hepatitis. The students and faculty member were able to attend a national meeting on hepatitis that was sponsored by the Rwanda Ministry of Health.

Methods

The students were able to work with a dataset and conduct a retrospective cohort study of 932 pediatric patients to analyze whether healthcare providers followed Rwanda national guidelines for their HIV-positive pediatric patients. National guidelines require that the following be done at clinical visits: record weight, provide bactrim prophylaxis, screen for and provide appropriate treatment for TB, initiate ART therapy appropriately, and provide the appropriate ART regimen. The students set a 90% threshold for guideline compliance. Data analysis included calculating proportions and using boolean logic and if-then statements to determine compliance to national guidelines.

Results

More than 90% of pediatric patients received guideline compliant care for weight checks, bactrim prophylaxis, and TB screening. The more complex guidelines for ART initiation and adherence led to less compliance in these areas. The main reason for non-compliance for ART initiation was found to be initiating treatment too early and contraindications due to drug-drug interactions for ART regimen compliance. The details of the results will be reported at the CUGH 2017 conference in April.

Reflections

High quality care requires continuously updating and training providers and regular mentorship to ensure providers understand the rationale behind their national guidelines. Rwanda as a country has made a significant and systematic effort do this for their providers. Students came to an understanding that caring for a patient is and will always be team-based and that interprofessional care is essential for providing high quality care. The students gained a new perspective on health care delivery in a resource-limited country such as Rwanda, and gained a greater appreciation for the history, culture, and people of Rwanda.

Read the student presentation made at UMB Institute for Global Health's Summit, September 2016.

Read the poster that the students presented at the 2016 annual meeting of the Consortium of Universities for Global Health.