The Ministry of Health, last week launched the Rwanda population based HIV Impact Assessment (RPHIA) in Kigali.
According to officials, the national household-based survey will aim at measuring the reach and impact of Rwanda’s HIV prevention, care and treatment services across the economy.
Data, which will be collected from RPHIA, will provide critical insights on the success and challenges Rwanda faces in confronting the HIV epidemic.
Demographic, clinical and behavioral information from consenting participants will be collected, as well as HIV and hepatitis B and C testing.
All these aim at helping in estimating new HIV infections (incidence), number of people living with HIV (prevalence), and viral load suppression among adults and adolescents.
Understanding hepatitis B &C, and HIV/AIDS
According to officials, hepatitis B and C are emerging diseases in Rwanda, a reason they say is because they have been known recently.
Janvier Serumondo, the director of hepatitis and STI at Rwanda Biomedical Center (RBC) says the program of dealing with hepatitis B and C kicked off in 2011 and soon after 2014, the guideline started, while the treatment was available in 2015.
For the screening campaigns, he says it started in 2016 and that for now there are ongoing campaigns throughout the country, for people to get screened; and if some are found to be positive, they can be treated to prevent its spread.
According to Dr Sabin Nsanzimana, the Division Manager, HIV/AIDS at RBC, people living with HIV are among high risk population to get hepatitis B and C.
This, he says is because of the fact that both diseases have the same mode of transmission and are immunodepressed.
Jean Damascene Makuza, STI care and treatment senior officer at RBC says HIV/AIDS and hepatitis B & C share the mode of transmission whereby they can be acquired in blood products and sexual fluids, as well as from mother to a child.
He also notes that all of them can induct people to immunodepression, and that some complications are almost similar.
Similarily, Makuza says that the risk factors for both diseases are the same and most importantly; just like HIV/AIDS, hepatitis B can’t be cured.
"When we talk of hepatitis,” Makuza says, "it is an inflammation of the liver that can be caused by viruses or toxic substances (e.g. alcohol).”
Health experts checking on patients; Hepatitis B and C need to be screened just like HIVAIDS./All Photos by Lydia Atieno.
The importance of screening and treatment
The main goal as to why people should make an effort of going to health centers or facilities and getting screened is to reduce cases of new infections and get better treatment as well.
"It helps people to be identified so that they can be enrolled for treatment, during this time there is reduction of mobility and mortality at the same time among the Rwandan population,” says Nsanzimana.
The government of Rwanda has made a lot of effort when it comes to availing the treatment for hepatitis.
Serumondo reveals that the treatment of these diseases is very expensive and that after Egypt, Rwanda is among the African countries that are and have implemented strong hepatitis treatments.
He says the treatment is available all over the country, noting that treatment for hepatitis C, the is for a shorter time ranging from three to six months, and one can be completely cured.
He however notes that when it comes to hepatitis B, the case is different and to date, it’s not yet curable. Research is ongoing to avail the curable treatment, but in the meantime, the disease is a lifelong treatment just like HIV&AIDS.
"The most important aspect when it comes to hepatitis B is that it can be prevented. This makes its prevention stronger than that of hepatitis C, in any childhood vaccination center, the vaccine is there therefore easy to prevent,” he says.
Complications
Serumundo says that viral hepatitis is liver inflammation due to a viral infection.
Makuza explains that hepatitis B (HBV) and C (HCV) are most prone to cause chronic infection. For this reason, these 2 types have been the focus in national health strategic plans to combat viral hepatitis.
"Both types of viruses cause acute infection, which may progress to chronic infection in some cases,” he says.
On the other hand, Serumondo says that many of those chronically infected with virus manifest show no obvious signs or symptoms for decades, although if left untreated, chronic infection can lead to fibrosis (scarring of liver tissue), cirrhosis (extensive scarring of the liver, later stage of fibrosis) and hepatocellular carcinoma (HCC).
People lining up for free Hepatitis vaccine during the World Hepatitis Day last year.
Measures put in place
Serumondo says various labs have been put in place nationwide so that all health care facilities, health care centers to referral hospitals, can diagnose hepatitis B and C.
"We are trying to reduce the mobility and mortality of these diseases by screening and getting the exact number of people with them,” he says.
According to statistics from RBC, it indicates that there is prevalence’s of both hepatitis B and C among specific groups. For instance, for hepatitis B it’s around 4 percent and for hepatitis B there is no specific number.
For C, the statistics indicates that there are a lot of differences in age categories, where younger people have lower prevalence while older ones have higher.
For instance, people aged 45 and above have 8 percent while those aged 65 and above have around 70 per cent prevalence. Younger people aged 25 and below have around 4 per cent.
Residents were able to be screened during the launch.
Practices to adopt
For Hepatitis B, Makuza says that childhood vaccinations are in place to prevent it, and that there are vaccinations for adults as well.
He explains that vaccination for Hepatitis B is stronger than that of Hepatitis C and that unlike Hepatitis B, there is no vaccine for Hepatitis C.
"It’s for this reason that we mobilize people to get screened and if they are found not to have any of the two, getting vaccinated will be better option, especially for Hepatitis B which can’t be treated when one has contracted it,” he says.
Alternatively, he says people should ensure they practice safe sex such as using condoms, to avoid liquid contamination which leads to transmission of the viruses.
He notes that, to stay away from both two types of hepatitis, one should also avoid the habit of sharing sharp objects such as needles, razors among others to avoid contact of blood.
Dr Nsanzimana says there is also increasing awareness among the general population on how the viruses are transmitted, how they can be prevented and where people can access information and treatment within the country.
According to him, this is just another strategy to ensure that people are aware of the habits that can lead them to contracting the virus, which help them to avoid or stay away from them completely.
There is also capacity building for health care professionals including medical doctors, nurses and lab technicians to foster the prevention, early diagnosis of infections and early treatment at each health facility in Rwanda.
In line with this, there are national guidelines for healthcare professionals dealing with infected persons.