HIV and TB Overview: Rwanda

Background

CDC has supported the Rwandan Ministry of Health (MOH) since 2002 in strengthening the national public system.

Together, we address HIV and tuberculosis (TB) through:

• Workforce capacity building.
• Epidemiology.
• HIV prevention among key populations.
• Improving case finding.
• Providing high-quality HIV and TB treatment.
• Strengthening the public health infrastructure.

HIV and TB data

HIV/AIDS

Tuberculosis (TB)

Key activities and accomplishments

Strengthening clinical services

CDC provides direct support and technical assistance (TA) to build expertise for MOH’s facility-based HIV/TB clinical services. These services provide comprehensive, integrated clinical prevention and treatment. Some examples include TB Preventive Treatment (TPT) and six-month multi-month dispensation of optimized antiretroviral treatment (ART).

TB Preventive Treatment

To reduce the TB burden among PLHIV on ART, PLHIV are routinely screened for TB disease. PLHIV diagnosed with TB receive treatment. Those without TB receive TPT to reduce their chance of acquiring TB.

Rwanda’s TB treatment success rate for all forms of TB is 89 percent. TPT services have been scaled up to all HIV care and treatment health facilities nationally.

HIV Treatment

CDC maintains the quality and sustainability of ART services by supporting “Treat All” and the differentiated service delivery models. These models include monitoring to identify challenges and inform strategic planning. As of 2022, 4,266 new clients with HIV infections were initiated on ART. Furthermore, the loss to follow-up rate was only 0.2 percent.

These treatments are available for adults and children at all 192 CDC-supported care and treatment sites. Support will expand to include TA for non-communicable disease and HIV integration implementation and advanced HIV disease management in FY24.

Strengthening laboratory systems

CDC supports the national laboratory network and quality management system (QMS), laboratory commodity security, and workforce development. It also supports laboratory information systems (LIS) for HIV, TB, and other important diseases.

Sustained HIV epidemic control

Support towards sustained HIV epidemic control includes:

• HIV drug resistance surveillance.
• HIV rapid and early infant diagnostics.
• Recency.
• Viral load testing.

The viral load testing network was fully connected with the LIS. Additionally, the NRL attained international accreditation (ISO15189) in 2021. These accomplishments allowed local laboratories to achieve QMS certification.

Reduced turnaround times

CDC also supports reduced turnaround times of core HIV test results through:

• Continuous quality improvement.
• Nimble rollout and use of LIS by healthcare providers.
• Improved site-level lab/clinical interface.
• Optimization of specimen referral system.

The laboratory network infrastructure, established with support from PEPFAR, was used in the Rwandan Government led COVID-19 response.

Strengthening HIV prevention activities

CDC provides MOH with financial support and TA for:

• Targeted HIV case finding.
• Linkage across the continuum of HIV services.
• Comprehensive HIV services to key populations.
• Prevention of mother-to-child transmission (PMTCT).
• Pre- and post-exposure prophylaxis (PrEP and PEP).
• Voluntary medical male circumcision (VMMC).

Case finding, linkage, and services

As of 2022, CDC implementing partners scaled-up index testing nationally to increase HIV case detection. They also initiated a social network strategy to reach, test, and link hidden at-risk populations to treatment.

Preventing mother-to-child transmission of HIV

CDC supports the country’s effort to eliminate mother-to-child transmission of HIV. One effort to keep mothers alive is to provide ART to HIV positive pregnant and breastfeeding mothers and their children. In 2022, the HIV prevalence among all women in antenatal care was estimated at 1.86 percent (MOH National HIV Report, 2022). National data indicate that 98.14 percent of HIV exposed infants tested negative at 24 months during the PMTCT follow-up period.

PrEP and PEP

As of 2022, 3,571 persons have been initiated on PrEP from key populations, serodiscordant couples, and adolescent girls and young women.

Voluntary Medical Male Circumcision

As of 2022, CDC implementing partners performed 96,353 VMMCs.

Strengthening health information systems and surveillance

CDC supports activities that strengthen health information systems, surveillance, and field epidemiology.

Information systems

CDC supports and provides TA on using electronic health information systems to collect, analyze, and disseminate data. The data from these systems helps CDC Rwanda and the host government make important decisions. These decisions can determine how to improve HIV prevention and treatment program performance and individual health outcomes.

Surveillance

Moreover, the existing case-based surveillance system provides patient level data on new individuals with HIV. It also provides information on the treatment outcomes of people living with HIV (PLHIV) in PEPFAR and CDC-supported health facilities.

CDC Rwanda, with its partners, provides updates on Bio-Behavioral Surveillance Surveys and Population Size Estimation data for key populations. They also use this data for modeling national HIV estimates every two to three years.

Field epidemiology training program (FETP)

CDC supported 64 FETP-Advanced and 232 FETP-Frontline graduates. Over 80 percent of the graduates have been deployed to Government of Rwanda institutions, providing epidemiological and public health leadership. FETP residents have led and responded to over 70 outbreaks and authored 40 scientific publications. These publications have informed public health policies and decisions.

Resources

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