PEARL “AGASARO”

Eugenie INGABIRE

Adherence&Linkages Team Leader

ICAP-Rwanda

Peer Educator for Adherence, Referral and

Linkages (PEARL) Program

Background

• 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 (PLHA) and district health teams.

PEARL specific objectives1. Improve adherence to continuity care and medications for

HIV infected patients enrolled in different programs (PMTCT mother-infant pairs, pre-ART adults and children, TB/HIV patients, adult and infant patients on ART)

2. Strengthen linkages between services at health facilities and referral between health facilities and communities for patients enrolled in HIV programs, through enhanced peer counseling, community mobilization for access to HIV services, and psychosocial support.

3. Improve overall health facility services uptake by the community (ANC, VCT, Family planning, etc.)

PEARL Framework

Communities/Families

Communities/Families

Communities/Families

Communities/Families

B- Tracing and

referral b

tw FOSA

and communities B- Tracing and

referral btw FOSA

and communitiesCBT expansion

Implementing partners

NGO Districts

ARBEF

•Karongi, •Ngororero •Rutsiro

BAMPOREZE

•Nyarugenge•Kicukiro•Gasabo•Rubavu•Nyabihu

NGO scope of work - 3 strategic domains

1. Mobilize and sensitize local authorities, district health teams and the community leaders to introduce the PEARL program.

2. Provide technical assistance to the local associations of PLHA and district health team for the implementation of the PEARL program

3. Ensure supervision and financial management of the peer educators recruited within the PEARL program

PEARL activities

-PEARL empowers and involves PLWHA in HIV prevention, care and treatment activities

-The program reached difficult group: prisoners

PE training -ICAP Rwanda trained 26

trainers and 511 PE among 301 from ICAP supported sites (including Kigali Central Prison) and 160 PE respectively from FHI (120) and Lux Dev (40) projects

- Minimum education: write and read in community and prison: 6 years of primary school

-Majority are women but in Prison men are majority

Peer Educator kit

• Mountain bicycle• Rain cots• Umbrella• Boots• Socks (2 pairs)• Bags• Radio (with batteries)• Torch (with batteries)

• Registers• Pens• Document file• Ruler• Watch• Megaphone with

batteries (1/association)

• ID card

Strengthens

• Increased uptake of services by community members (VCT, ART, PMTCT, Exposed Infant Follow up, FP, etc.)

• Greater coordination between services, & increased accessibility for patients

• Systematic TB screening & referral to diagnosis for families of association members

• Enhanced patient tracing leading to reduced loss to follow up

• Further empowerment of PLHIV as service providers and recipients

Challenges

• Difficult to conduct home visits at Kigali sites with large, mobile patient populations

• Difficult to reach patients outside facility catchment areas

• Variable experience and skills of Social Workers, Peers

• Providing adequate motivation and transportation for Peer Educators (bicycle maintenance)

• Resistance to Family Planning service delivery at some health centers

• Need for Peer support often exceeds capacity

Acknowledgements

o MOH/Community Health Desko CDC-Rwandao RRP+o ARBEFo Bamporezeo All Site Staffo Peer Educators & Patientso ICAP Rwanda team