Aides visuelles

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昶甸仙
5 years ago
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1 AMP mission to Rwanda October 1 to 8, 2009 Alysa Krain MD, MSc Betty Lafourcade, PhD

2 Agence de Médecine Préventive (AMP) Background Non-profit organization created in 1972 (Foundation Mérieux and Pasteur Institute) Missions Promote preventive medicine and public health by implementation of field research on infectious/communicable diseases Develop human resources for health system strengthening (training) Provide expertise in public health by partnering with countries & international organizations Organize technical seminars or meetings of stakeholders in international health. Areas of interest/expertise Field based epidemiological research (surveillance systems) Epidemiological training programs (Epivac) Transfer of laboratory technology to developing countries Capacity development (SIVAC*) WHO TB Task Force member since January 2009 Asked to provide technical assistance to Rwandan team *Supporting Independent Immunization and Vaccine Advisory Committees 2

3 Background on Rwanda Population 2008: 9,822,186 (NISR* 2009) Population 15yr: 58.0% (NISR 2009) 2007 WHO est prevalence SS+ in adults: 252/100K Notification rate (new SS+/ pop/yr): 48 (2008) Case detection rate SS+: 19% TB Patients tested for HIV: 96% (2008) TB HIV co-infection: 34% *National Institute of Statistics of Rwanda 3

4 Rwanda 4

5 Goals of AMP mission in Rwanda To assess national capacity and preparedness for the survey Identify potential bottlenecks in preparation and implementation of the survey To develop action plan to strengthen and build laboratory capacity for the prevalence survey To come up with a list of recommendations related to study logistics, regulatory requirements, human resources and training To assist the NTP in the development of a high quality protocol and data collection tools NTP (National TB Program) 5

6 6 AMP mission activities (1) Met key players from NTP, Rwandan School of Public Health (RSPH), WHO and other partners who worked in preparation of the protocol Learned about standard activities of the NTP (surveillance, diagnostics, training) Visited the national reference laboratories in Kigali to assess capacity (equipment & personnel) Met with a senior researcher at the National Institute of Statistics to discuss their involvement in the survey and study regulations.

7 AMP mission activities (2) Discussed radiological issues of the survey with radiology staff at the Kigali medical center Discussed laboratory issues of the survey with laboratory partners implicated in the survey (NRL, ICAP, Damien Foundation) Worked on sample size calculations/sampling frame with a researcher from the RSPH NISR (National Institute of Statistics of Rwanda); NRL (National Reference Laboratory); ICAP (International Center for AIDS care and Treatment Program); RSPH (Rwandan School of Public Health) 7

8 8 Bottlenecks identified (1) General NTP activities focused on acquiring funding in order to proceed with all survey planning and activities Survey organization not yet formalized (steering committee, survey coordinator) Terms of references yet to be clearly defined Survey design and methods still under discussion (SOPs pending) Survey protocol needs revising to reflect the reality of the field activities

9 9 Bottlenecks identified (2) Epidemiological Survey design, sample size, sampling frame and methods still under discussion Enumeration zones (EZ) may need updating (numeration of households) Study regulations (approval of Ethics Committee of MOH and NISR) Laboratory Procedures still under discussion - dependant upon clusters/ezs chosen (clinic based vs mobile teams) Procurement procedures very slow and complicated One reference lab currently operational for TB (2 pending for «2010») Laboratory personnel skills (culture) need evaluation and equilibration (training)

10 10 Bottlenecks identified (3) Radiology Shortage of radiologists (6 in-country/3 public sector) District doctors trained by NTP/WHO on radiology need to be assessed by radiologists (further training?) Radiological study procedures still under development Study sites will likely need improved infrastructure and equipment/materials for radiological procedures Data management/analysis Relationship between the Rwandan School of Public Health and NTP not yet formalized Data related activities yet to be started (analysis plan, data base etc) Training Survey specific training planning yet to be started

11 11 Initial recommendations (1) Formalize steering committee (SC) and relationships between SC members and the NTP Recruitment of full time survey coordinator, financial manager and logistics manager Recruit/designate unit heads (create terms of references)

12 12 Initial recommendations (2) Revision of protocol and data collection tools with formalized survey personnel/sc Once clusters/ez identified, perform systematic site assessments of healthcare centers where radiological (and possibly laboratory) studies will be performed Perform assessment of laboratory/radiological personnel implicated in the survey

13 13 AMP Next Steps Preparation of mission report with formal recommendations for WHO and the Rwandan team Seek funding for long term technical assistance to the Rwandan team

14 Thank you for your attention! 14

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