Although the Rwandan Government has made primary school free for all children, addition school-related expenses prevent the poorest of Rwandans from taking advantage of this free education. Uniforms, school supplies, books, food and transportation are among them. The government also provides a small number of secondary school scholarships to the most qualified students. All other students need to pay a small fee to attend school. Often, this fee is equal to or greater than a family’s entire annual income. WE-ACTx Children’s Education Network is a volunteer-driven initiative to increase access to formal education and nutrition for children of WE-ACTx’s grassroots partner organizations. The program is small at present, linking children from one grassroots partner community with a US church and other institutional membership to “sponsor” children throughout their educational careers. WE-ACTx acts as an administrative conduit to the program, organizing purchase of school uniforms and supplies, payment of fees directly to the schools of the children, and provision of nutritious breakfasts for the children, their younger siblings, and breastfeeding and pregnant mothers. The grassroots partner organizations from which the sponsored children come organize the daily breakfasts and distribute school supplies purchased through the program.

With initial seed funding from the Stephen Lewis Foundation, private donors, and recent support from the Human Rights and Democracy Fund of the US embassy in Rwanda for translation of the Legal Handbook into the local language and further trainings in the country, we are building on the solid foundation of WE-ACTx’s primary health care services to help Rwandans address sexual and other forms of violence against women and children and remove barriers to health care access in Rwanda.

Handbooks

Know Your Rights! A Community Handbook on Health-Care Rights and Other Laws
(Download PDF documents below)

• English
• Kinyarwanda

WE-ACTx for Hope participates in a countrywide collaborative HIV prevention and outreach program in which large scale community mobilization and sensitization campaigns are implemented throughout the country. WE-ACTx for Hope trains HIV+ peer educators within our grassroots partners using a ”train the trainer” model, imparting skills in basic HIV prevention and positive living with the goal of creating an informed cadre of Rwandan grassroots health educators throughout the country. WE-ACTx for Hope holds workshops with grassroots organizations and collaborates with WE-ACTx’s family program and trauma counseling activities.

In-house sewing and crafts cooperative

WE-ACTx has organized its own in-house sewing and crafts cooperative, INEZA, to make dolls, clothing accessories (hand bags, computer sleeves, etc.) and other crafts for sale in the international market as an effort to develop a sustainable source of income for women on HIV treatment. Over the past year, we have developed a marketing and distribution arrangement for clothing accessories products with Connect USA. We are planning to develop markets and production capacity for Rwandan domestic sales as well, linking our production with overall economic development efforts in country. The women who make up our cooperative are paid weekly wages, receive transportation and food supplements, and of course, are provided with HIV care and treatment – and YOGA!

go to INEZA’s blog

Clinical goals for these children include the provision of state of the art HIV medical care which includes full access to ARV therapy, to reverse disease progression. ongoing medical monitoring, and all medically indicated prophylaxis and treatment of opportunistic infections and other co-morbidities. We have learned from our two years of experience in assessing HIV affected children within their home environments, that 20% of the children in the program will exhibit signs of serious depression and/or PTSD, and we therefore also provide psychological monitoring and care.

In collaboration with our grassroots partners and the Rwandan government, WE-ACTx has provided VCT services since October of 2005, with both fixed and mobile teams, testing over 24,500 women, children and men. Our mobile teams coordinate with our grassroots partners to bring the services deep into the community, with advance outreach.. VCT is provided in a family-centered model, with each family member offered testing, and all family members of People Living with HIV/AIDS (PLWHA) being encouraged to test. Our mobile and community-oriented approach increases the likelihood of reaching vulnerable populations, including orphans and traumatized women, who are less likely to seek VCT in centralized medical settings. Identifying HIV infection in multiple family members, and referring them to immediate medical care prevents the family from sharing their medications (which results in inadequate treatment and can lead to virologic resistance to antiretroviral treatment), or having to choose which members will receive treatment—all will be treated appropriately. For families with HIV infected children, additional counseling and support are provided through our grassroots partners, to help ensure that their special needs are met.

Our community-based and family-centered testing also allows us to reach more pregnant women. In Rwanda less than half of pregnant women access prenatal care or deliver their infants in attended medical settings, and thus do not access VCT or programs for Prevention of Mother to Child Transmission (PMTCT). Linking pregnant women to these services is a key goal. As important feature of VCT is to link it to medical services for immediate care, which both ensures early initiation of ART for those who need it and for most patients mitigates the distress and anxiety of a positive diagnosis, in that they are able to take action. WE-ACTx is working with our partners and health officials to implement this replicable model of service, demonstrating that a full access public health approach to HIV testing and care in a community is both feasible and affordable, resulting in a renewal of health for the entire community. With the help of a generous grant from the Stephen Lewis Foundation for 2008, we will be expanding this important program.

Centreville Clinic
Our flagship clinic in Centreville houses our Collaborative Research Program (RWISA) as well as providing clinical care to our patients. The building houses WE-ACTx’s head office in Kigali. A range of primary health care and clinical services centered through the Centreville Clinic are generously supported by the MAC Global AIDS Fund, one of our earliest funders.

WE-ACTx has designed and implemented community-based HIV clinical services and primary health care programs in 3 clinics utilizing this community based nurse-practice model through partnerships with grassroots women’s organizations and the government of Rwanda. Nearly 5000 HIV+ individuals have entered care with WE-ACTx, with nearly 1300 requiring ART, and 70% requiring prophylaxis of opportunistic illness. We provide clinical care and treatment for HIV to women, children, and men, who are into care by our grassroots partners via collaborative community outreach and mobilization programs. Patients needing further care and hospitalization are referred to district hospitals and supported by WE-ACTx’s community trained nursing and other support service staff.

KCA Centre for Excellence
Icyuzuzo Clinic

Our second clinical care project, a partnership with a local NGO, supported by the Keep A Child Alive Foundation, and individuals.

Nyacyonga Centre de Santé
(Community Health Center)

Our most recent clinic project: With support from American Jewish World Service and the generosity of private donors, WE-ACTx updated this district health center on the outskirts of Kigali in 2006 and early 2007. Nyacyonga Centre de Santé (Community Health Center) is one of ~130 publicly owned facilities operated by the Government of Rwanda through its decentralized District Health system. These health centers are extremely important to the communities as the first site for community access to all needed services, including prenatal care, birthing, well-child care including vaccinations, diagnosis and treatment of acute illnesses such as malaria and endemic infectious diarrhea, and HIV evaluation, care and treatment with antiretroviral (ARV) medications. WE-ACTx has partnered with the District to provide technical assistance in provision of high quality cost-effective HIV care, integrated into the community’s care. This required significant upgrading of the physical plant, such as provision of running water and electricity to all patient areas and an improved array of equipment to allow a full spectrum of high-quality services.

Voluntary Counseling and Testing:

WE-ACTx began its VCT program in September 2005. We now have a stationary and 3 mobile VCT teams in Kigali and greater Kigali, each staffed by a 3-4 counselors and a lab technician. We now provide VCT to ~1300 people a month in a family-centered model. HIV-positive individuals are referred immediately for medical evaluation at WE-ACTx’s or partner NGO clinics for rapid entry into care. Currently 100% of children and ~90% of HIV-positive adults are in care.

HIV Care and Treatment:

WE-ACTx operates two clinics in Kigali that offer a comprehensive medical service, free of charge. To date, we have ~ 4000 patients. Approximately one-third of patients require ARV treatment, and 70% of patients receive prophylaxis HIV treatment. WE-ACTx is now working with the Rwandan government to help upgrade public health sites.

Family Program/Pediatric Care:

KidsWE-ACTx provides a comprehensive continuum of care to HIV infected children and their families through an integrated medical and psychosocial service delivery model, informed by the partner associations. Care will begin with VCT, continue at the WE-ACTx clinical sites, and include home visits, social needs assessment, educational support groups, emotional counseling, permanency planning, and assessment and enhancement of the community understanding of families affected by HIV.

National Cervical Cancer Screening Program:

WE-ACTx is collaborating with the Rwandan Women’s Medical Association, Ministry of Health and partner NGOs to develop a national cervical cancer screening program.

RESEARCH

The Rwanda Women’s Inter-Association Study (RWISA):

WE-ACTx initiated a research program – the Rwanda Women’s Inter-Association Study and Assessment (RWISA) – in 2004 to study HIV in Rwandan women, in collaboration with Rwandan investigators and NGOs. RWISA is a longitudinal cohort study that is following ~1000 Rwandan women, including over 50% who are survivors of genocidal rape. It will assess the impact of HIV disease and treatment, trauma and nutrition on their health. RWISA is funded by National Institute of Allergy and Infectious Disease (NIAID) is a sister study to the 13-year US Women’s Interagency HIV Study (WIHS). RWISA developed a cell-separation lab and a specimen repository in collaboration with the National Reference Lab in Rwanda. RWISA is revising and expanding the nutritional investigations in RWISA in collaboration with the Rwandan government, World Food Program and groups involved in nutrition. We work with the National Bureau of Statistics to develop Rwandan capacity in data management and analysis. For a more detailed description of RWISA’s history click here.

NON-CLINICAL SERVICES:

Supplemental Nutrition:

WE-ACTx offers supplemental nutrition, provided by the World Food Program, to patients taking ARVs, and nutrition education. WE-ACTx collects data on the benefits of supplemental nutrition in these patients. To date, over 700 patients are enrolled. After 6-9 months they are referred into income-generation programs that can provide a sustainable source of income to purchase food.

Income Generation:

WE-ACTx started small income-generating projects for our ARV patients, including a sewing and crafts cooperative, who make dolls, crafts and products for sale. We work with Heifer International to help our partner NGOs develop livestock and gardening programs.

Peer Education/ Training of Trainers:

WE-ACTx has established a community HIV Training of Trainer program and Peer Education program. Our new “A Healthy Life with HIV – A Community ToolKit” is a family-oriented course recently selected to become a national curriculum.

Community Legal AID Training:

WE-ACTx has piloted a community Legal AID Training for paralegals and community advocates around on HIV/AIDS and the Law, and on sexual violence.