FHI - Nurse Training Program Strengthens Clinical Care

March 2007 — Rwanda is among the 10 countries in Africa most severely affected by HIV and AIDS, the World Health Organization reports. In 2003 WHO estimated that 170,000 to 380,000 people in Rwanda were living with HIV/AIDS, and thousands more may be unknowingly infected. Motivated by these grim facts, Rwanda developed national policies on testing and treatment for HIV/AIDS and has ambitious goals to increase the number of clinical sites offering antiretroviral therapy (ART). But with some 400 doctors for its population of 8.4 million, Rwanda's physicians cannot meet the country's growing healthcare demand.

To help the government scale up HIV patient care, in June 2005 FHI launched a three-year USAID-funded pilot project to increase nurses' capacity in clinical care, including initial patient screening and prescription of first-line antiretroviral therapy. The program is offered at three clinical sites, in Kivumu, Nyarusange, and Nyabikende, through June 2007, with the potential to be extended.

In Rwanda nurses provide most HIV patient care, including support and counseling for antiretroviral therapy patients. Unless they graduate from this pilot program, however, nurses may not prescribe antiretroviral drugs (ARVs). Working side-by-side with the doctors who supervise them, nurses in this program receive practical training in examining patients and prescribing treatment.

Like all Rwandan nurses working at sites that prescribe antiretroviral therapy, nurses in the program have already received extensive training in HIV care and treatment. However, the hands-on experience offered through the pilot program helps them build the skills they need to confidently prescribe ART, monitor patient health, and refer patients to doctors as needed. "These sites could not have ARV services if it were not provided by the nurses," said Misti McDowell, senior program officer with FHI/Rwanda. "There are just not enough doctors."

Nurses in the program use tools developed by the Rwandan Ministry of Health and FHI, including checklists of symptoms and lab exams to follow during examinations. Health practitioners hope that this program will help meet the challenge of expanding access to ART in a country facing a critical shortage of doctors to diagnosis and monitor patients.

By the end of December 2006, three nurses trained through the program were providing HIV care and followup to 264 clients on ART. Evariste Ngamije, the first nurse to complete the pilot training program, works at the Kirambi Health Center in southern Rwanda. "I was very interested in the program," he said, "because the training would allow me to help patients from our region to be on ART near their homes, at a health center they frequently use."

Doctors and nurses at sites benefiting from the program recognize its potential for lightening doctors' caseloads and moving more patients into treatment quickly. "This approach allows doctors to use their time more rationally to support the nurses and concentrate on the more difficult cases," said Dr Fabienne Shumbusho, FHI/Rwanda's coordinator of medical services. "It also recognizes the critically important role that nurses play by helping them to increase their knowledge and build their capacity."

PHOTO: Dr Bruno Ngirabatware explains an ARV regimen to a patient at Biryogo Health Center. Rwanda faces a shortage of physicians even as it seeks to scale up access to ART. (FHI/Rwanda)

As a leading partner in clinical services, FHI supports comprehensive HIV/AIDS services at six hospitals and 37 health centers in Rwanda, most in rural areas.