Rwanda is working to scale up integrated care for older people living with HIV, combining HIV treatment with the management of non-communicable diseases (NCDs). Globally, the number of people aging with HIV has been increasing, thanks to scientific advancements in treatment. In Rwanda, for instance, 73,102 people (up to 30 percent) of all those living with HIV are aged 50 and above. These people are dealing with more than just HIV, as they are more likely to develop non-communicable diseases like hypertension, diabetes, heart disease, and even certain cancers, often earlier than HIV-negative people, said Deo Mutambuka, Executive Director of the Rwanda Network of People Living with HIV (RPP+). He said that the complications are caused by a combination of factors including aging, lifestyle, and the effects of being on long-term antiretroviral medication. The New Times has learned that Rwanda Biomedical Centre (RBC) is rolling out a one-op shop model that brings HIV and NCD services at the same health facility. We want people to receive HIV treatment and be screened for other conditions in the same place. This is already happening in health centers across Kigali, said Dr. Jean Claude Kwizera, the Senior Officer for Adult HIV Care and Treatment at RBC. He noted that facilities in Kicukiro, Gikondo, Busanza, and Masaka are offering integrated services, and the approach is being expanded to Nyarugenge District in partnership with the NCD Alliance. “All health centers provide NCD screening and refer patients where necessary. It’s part of the package now. RBC is also preparing to train healthcare workers on managing older adults with HIV, with new sessions expected to begin in August, he said. “Our HIV-positive population is aging. This is now a priority, which is why we are training providers to understand this shift, and we collect data on older patients to help guide planning and services,” he added. While Rwanda has reached the global 95-95-95 targets, meaning 95% of people living with HIV know their status, 95% of these are on treatment, and 95% of those on treatment are virally suppressed, Dr. Kwizera acknowledged gaps. He noted that viral suppression rates are higher among older people, but they also face a greater burden of other illnesses. “Some treatment combinations can be difficult for older patients to tolerate, so the healthcare system must adapt to meet their changing needs.” Dr. Gilbert Mbaraga, a medical officer at the AIDS Healthcare Foundation (AHF), said that many aging people have diabetes or hypertension, which is why AHF introduced primary screening for these conditions. Since January, all AHF-supported sites have started integrating NCD checks into routine HIV care. Initial staff training was completed already and procurement of screening tools is ongoing, he noted. “We have already received equipment like glucose kits and weighing scales. Blood pressure machines are still being procured, but we expect all sites to be equipped by the end of the year,” said Dr. Mbaraga. He added that the screening includes blood pressure, glucose levels, and body weight. The aim is early detection and referral for further care where needed. The integration effort is aligned with the Ministry of Health’s guidelines and is being implemented in coordination with RBC. Dr. Mbaraga said his team is discussing the introduction of elderly care measures with RBC, adding that they are looking at how to systematically include aging needs in all their services. He said that healthcare workers are urged to screen older patients at every visit. Those with diabetes or hypertension are monitored and referred for care.
