An evaluation of a case management program for HIV clients in Rwanda

The purpose of this work is to demonstrate the application of case management to HIV/AIDS in a developing country context. In September 2004, CARE International initiated a case management program in Rwanda designed to enhance linkages between community and facility-based services for people living with HIV/AIDS (PLHA). The evaluation focused on program implementation and program outcomes including responsibilities and resources of case managers, community linkages, integration within the health facility, ARV adherence and quality of life among PLHA. Qualitative data was collected from case managers, clients, health care providers, and CARE staff via focus group discussions and in-depth interviews. A survey was conducted among 75% of the 149 case managers. Results indicate the program facilitated PLHA's access to care and support services and strengthened linkages between facility-based and community service providers. Most case managers (79%) reported inadequate resources to carry out their duties and high client loads, averaging 63 clients each. They also had limited referral networks. Nonetheless, case managers were highly regarded and appreciated by health professionals, who reported the program helped to enhance patient-doctor relationships and ensure follow-up on patients' needs. Respondents further highlighted benefits of improved psychosocial wellbeing and better adherence to antiretroviral medications among clients. Issues remain in terms of case management efficacy in developing country environments, notably the availability and accessibility of needed care and support services. Despite some limitations, data suggest case management is a viable strategy for providing comprehensive support to PLHA in Rwanda and its implementation elsewhere in Africa should be considered.