Columbia-supported HIV/AIDS Initiative
in Rwanda Gains Speed
Country moves to large scale treatment and care for thousands
What does it take for a country to begin fighting AIDS head on? Ten years after the genocide in Rwanda, Columbia University is working closely with the Government of Rwanda and its partners to expand what is rapidly becoming one of the most successful HIV/AIDS initiatives on the continent. The Earth Institute at Columbia University and the Mailman School of Public Health are supporting this initiative jointly. Three Columbia health policy and management experts have moved to Kigali, the capital of this East African nation of 8 million, to assist the government's health agencies in their effort.
"We have welcomed the team from Columbia to work hand in hand with our senior officials," says Agnès Binagwaho, M.D., who heads Rwanda's National AIDS Control Commission. "The support we have received from Columbia in an atmosphere of full cooperation has been a key to the rapid deployment of our national AIDS strategy."
Led by Assistant Clinical Professor Josh Ruxin of Columbia's Center for Global Health and Economic Development (CGHED), and funded by the Glaser Progress Foundation and the US Agency for International Development (USAID), members of the team assist the government of Rwanda in implementing the national HIV/AIDS treatment and care plan, write the supporting policies, recruit and train health personnel, and even figure out the logistics of distributing supplies. Along with Dr. Ruxin, Dr. Binagwaho serves as co-coordinator of the HIV task force of the Millennium Project, a United Nations initiative to cut global poverty in half by 2015 (www.unmillenniumproject.org).
Backed by the CGHED team on the ground in Kigali and using international financing, Rwanda has made HIV/AIDS testing and treatment available to thousands in just one year by training and equipping an expansive network of health facilities. Seeing such promising foundations and effective use of resources, the Global Fund to Fight AIDS, Malaria and Tuberculosis (www.theglobalfund.org) recently selected Rwanda for its Acceleration Initiative, an effort aimed at producing faster results in five high-performing countries and serving an even greater number of people than originally planned. One current goal of the Global Fund is to provide life-extending antiretroviral treatment for more than 20,000 people in Rwanda over the next five years. Rwanda has commitments from donors to treat a total of 45,000 patients with antiretrovirals, half of its estimated need.
"Rwanda is one of the few countries that uses its international funds efficiently, rapidly, and transparently," says Ruxin. "The challenges of creating a working program to fight HIV/AIDS and the challenges of creating a public health system that meets the needs of the poor and vulnerable are the same. We are working on more than HIV/AIDS we are helping Rwanda build its health system. The extraordinarily rapid advances we have made in just a year say a lot about the commitment of Rwanda's health officials."
In one example, Columbia successfully helped to manage the thorny problem of determining which HIV-positive patients would receive antiretroviral treatment. CGHED's Celina Schocken, who serves as chief adviser to the Rwandan Health Minister responsible for HIV/AIDS, helped draft a clear, carefully thought out policy. "The Rwandan authorities wanted to make the national policy on HIV treatment very transparent," says Schocken. "They wanted everyone who needs the treatment to know how they can get into the program and to have the same opportunity to access the drugs." To qualify for treatment, HIV-positive patients must not only meet clinical criteria but also several social criteria aimed at identifying those likely to stick with a complex treatment regimen. For instance, they must bring in a friend or family member as a "treatment sponsor" to ensure they take their medicines and receive medical attention when they are sick. Before joining the Columbia team, Schocken co-authored Rwanda's national HIV/AIDS treatment and care plan, supported by the William J. Clinton Presidential Foundation.
Meanwhile, Dai Ellis, a CGHED team member who was formerly a consultant at McKinsey & Co., has been busy writing funding proposals for additional Global Fund grants, planning and budgeting for program implementation, and transferring management skills to the Rwandan health officials who will carry the project forward. In addition, he has helped to establish inventory controls and drug supply forecasts to resolve bottlenecks that once threatened to derail the program's progress. Now, the national procurement agency in charge of forecasting the need for HIV testing kits and antiretroviral medications has implemented new operating methods so that the testing and treatment will always be available when needed.
The Center for Global Health and Economic Development is a joint project of the Earth Institute at Columbia (www.earth.columbia.edu) and Columbia's Mailman School of Public Health (http://www.mailman.hs.columbia.edu/). It includes the Access Project for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is funded by the Glaser Progress Foundation and the US Agency for International Development. Columbia's project in Rwanda also provides support for coordination between the National AIDS Control Commission, the Ministry of Health, the World Bank, USAID, the Global Fund, and other donors.
In addition to the Access project, CGHED staff members have worked with Rwandan health officials to establish a national Task Force on Macroeconomics and Health. The Task Force seeks to implement in Rwanda the recommendations of the World Health Organization's Commission on Macroeconomics and Health, which was chaired by Earth Institute director Jeffrey D. Sachs. The Commission's 2001 report, "Investing in Health for Economic Development," shows that, in addition to reducing suffering and improving well being, investing in health can be a concrete input to economic development, and indeed is essential for economic and social development in the world's poorest countries.
The Earth Institute at Columbia University is among the world’s leading academic centers for the integrated study of Earth, its environment, and society. The Earth Institute builds upon excellence in the core disciplines—earth sciences, biological sciences, engineering sciences, social sciences and health sciences—and stresses cross-disciplinary approaches to complex problems. Through its research, training and global partnerships, it mobilizes science and technology to advance sustainable development, while placing special emphasis on the needs of the world’s poor.