Projet San Francisco

Projet San Francisco (PSF) has been conducting HIV/AIDS research as well as providing clinical care and counseling for HIV-infected persons in Rwanda for over 20 years. Projet San Francisco is a tax-exempt registered non-governmental organization Dr. Susan Allen established in Kigali in 1986.

Since 1986, PSF has worked closely with the Centre Hospitalier Kigali (CHK), the National HIV/AIDS Reference Laboratory, and the Ministry of Health’s Treatment and Research on AIDS Center to improve clinical care available for HIV-infected persons. PSF runs an on-site couples’ voluntary counseling and testing facility, medical clinic, laboratory and pharmacy. It employs over 150 Rwandan medical and support staff and 5-10 expatriate interns and project coordinators. The CHK and the Treatment and Research AIDS Center are across the street from PSF. Physicians from the CHK rotate every afternoon in the PSF outpatient clinic. This ensures continuity of care when hospitalization is required. In addition to providing clinical care since 1986 for 95 long-term survivors of the project’s original HIV+ cohort, PSF also provides HIV voluntary counseling and testing for couples, with over 17,000 couples tested, 8,000 people provided with screening for sexually transmitted infections and 940 HIV discordant couples receiving general outpatient care at the PSF clinic. PSF maintains three CVCT sites in different districts of Kigali, as well as a mobile unit which changes location monthly. 

During the Rwanda genocide in April-July 1994, half of Kigali’s inhabitants were killed or fled leading to temporary suspension of PSF activities. In August 1994, the new government took control, survivors began to return and PSF research and clinical care activities resumed. Dr. Allen had resided in Kigali from 1986-1994 as PSF Director. During the genocide, she moved her family and staff to Lusaka, Zambia and established a sister site, the Zambia-Emory HIV Research Project, based on the PSF model.

Projet San Francisco’s infrastructure is divided into five departments: administration, CVCT, data, lab and medical. Please see Research Initiatives for further information regarding studies and funding at PSF.

PSF Administration Department

What does the administration department do?

The administration department maintains a staff of approximately 10 employees and keeps numerous vehicles in working order. The administration department’s many responsibilities are critical to the daily functioning of the project and the achievement of its research goals. These responsibilities include: finance/accounting, procurement, human resource management, government and research partner liaison, supply management, transportation, communication, security and office repairs/maintenance. Projet San Francisco currently consists of over 10 rental properties in Kigali, the capital city of Rwanda.

Human resource management includes monthly salary transfers, employee healthcare, disciplinary measures and leave day management, and helping to interview and hire qualified staff, among other tasks. Government liaisons are crucial for the annual non-governmental organization (NGO) registration, work permit applications and reclaiming taxes paid on locally purchased supplies. Transportation and communication are critical components for coordination among the different project sites. In addition, the department manages maintenance and renovations of project space as needed.

What does an administration intern do?

The PSF administration department has been under the direction of the Rwandan staff for the past ten years as administrators and administration assistants. There is not an intern position in this department. 

PSF CVCT Department

What does the CVCT department do?

PSF has offered couples’ voluntary counseling and testing (CVCT) services to over 17,000 Rwandan couples since 1988. PSF maintains three CVCT sites in different districts of Kigali, as well as a mobile unit which changes location monthly. Each site has between five and 10 full time counselors and a capacity to provide services to approximately 35 couples per day. Our most successful campaign of promoting couples’ testing relies upon Influence Network Agents (INAs), community members who have been recruited at each site to invite couples from their neighborhoods in for testing. Influence Network Leaders (INLs) operate in collaboration with INAs by giving public announcements to large groups regarding CVCT services. In addition to being a service provided to all couples, our CVCT program is the point of entry into PSF’s various studies and clinical trials. All couples are given the option to return to PSF’s CVCT centers for additional one-on-one counseling as needed.

What does a CVCT intern do?

CVCT interns coordinate the daily activities of the CVCT sites and organize efforts to ensure consistency. Responsibilities include liaising with community, political and religious leaders, working with INA administration/trainers, finances, scheduling, quality assurance, ensuring proper training of counselors, and organizing mobile units among other tasks. One of the primary goals of the CVCT intern is to empower the CVCT staff to be as self-sufficient as possible while acting as a liaison to other interns as well as outside organizations. The CVCT department provides monthly reports including information about each CVCT site and works closely with the Rwandan government and Ministry of Health to expand acceptance and use of CVCT services throughout Rwanda and facilitate integration and implementation on a national scale.

PSF Data Department

What does the data department do?

Projet San Francisco’s data department consists of a data intern and approximately 10 data entry staff. Data collection began in 1986, and the data department follows over 1,000 enrolled couples. All CVCT, laboratory and follow-up data are either manually entered or scanned using TELEForm. Data are quality controlled continuously during the data entry process. Reports and queries are generated to find errors or provide information for further analysis and the data department works closely with the other departments to ensure clean and accurate data. All departmental members are active in researching and resolving errors.

What does a data intern do?

In 2002, PSF welcomed its first dedicated data intern since the genocide in 1994. The data intern oversees the daily activities of the staff and ensures that error reports are run and resolved in a timely manner. The intern is ultimately responsible for receiving programs and sending data to the other sites as necessary. 

PSF Medical Department

What does the medical department do?

The medical department at Projet San Francisco consists of counselors, physicians and a medical team coordinator. The staff works together to provide quality medical care, administer contraception to study participants and collect data critical to studying the heterosexual transmission of HIV and natural history of the disease. Antiretroviral drugs (currently provided under the Global Fund initiative) are also available for eligible clients according to Rwandan guidelines. Couples who are found eligible during couples’ voluntary counseling and testing (CVCT) are referred to the medical department for enrollment into ongoing studies. The enrollment visit begins with a brief introduction to PSF and the consent form on video. A counselor meets with each couple privately to ensure consent understanding and provide additional counseling as necessary before the clients sign the informed consent. Each client is individually interviewed regarding his/her medical history, previous contraceptive use and demographic data. In addition, a full baseline physical exam is conducted to facilitate the diagnosis and treatment of any sexually transmitted diseases. The couple is given an appointment date to return in three months for their next follow-up visit. At each three-month visit, safe sexual practice is reinforced with additional counseling as necessary, and clients are interviewed about their health since their last visit. Clients with medical problems or family planning needs are examined and provided with treatment as necessary. At scheduled visits, clients are tested for syphilis and treated if necessary. Negative clients are also tested for HIV seroconversion since their last visit. A cohort of long-term HIV survivors enrolled during 1986-88 also comes to the project every three months for regular follow-up visits and medical care. All enrolled couples are welcome to return to the clinic at any time for medical care or further counseling if needed.

What does a medical intern do?

The medical department intern ensures that daily operations run smoothly, data is collected accurately and completely via quality checking all forms/records/lab results, and helps make decisions about whether couples should continue in the study. Quality checking also involves ensuring that the treatment provided to clients in the period between visits has been accurately recorded on the medical forms, and that any sexually transmitted diseases identified are treated. The medical intern will also act as a liaison between the medical and laboratory departments in the case of seroconversion or discrepant results, and as a liaison with CVCT to ensure that only truly eligible couples are referred and enrolled.

PSF Lab Department

What does the laboratory department do?

When Projet San Francisco began in 1986 it had only one laboratory technician.
Over the years, the laboratory department has increased to nearly 15 lab technicians including our very first. The laboratory works on a variety of activities involving laboratory diagnoses and analyses for the research clinics and the couples’ voluntary counseling and testing (CVCT) centers. The laboratory activities include specimen collection, labeling and storage, immuno-serology testing, microscopy, and hematology. The recent acquisition of ELISA testing equipment has increased the capacity of the laboratory department for the diagnosis of HIV and HSV-2, and for the early detection of HIV seroconversion.

What does a lab intern do?

The laboratory department intern is responsible for ensuring the appropriate, accurate, and expedient flow of specimens from collection to testing, communication of results, and entry of data into the project’s databases. The intern is also involved in the quality assurance and quality control of laboratory procedures as well as the external quality audit processes and the external quality assurance, and works closely with the project’s data department in the resolution of laboratory data errors generated from error reports. The lab intern coordinates the different protocols for the routine and special study visits, including seroconversion and p24 antigen positive protocols. The lab intern is responsible for ensuring that the lab techs perform peripheral blood mononuclear cell isolation, archive frozen samples in LIMS (Laboratory Information Management System) and keep an inventory of reagents and other essential consumables. The lab intern also works continuously to establish Good Clinical Laboratory Practice (GCLP) requirements and leads the laboratory in an accreditation process.