The Rwanda Biomedical Centre (RBC) is finalising preparations for the rollout of lenacapavir, a long-acting injectable drug for HIV prevention, expected to be introduced in November. The preparations include site selection, training of health workers, and procurement of essential supplies. ALSO READ: How Rwanda met global HIV targets ahead of schedule The injectable, which is administered once every six months, will be added to Rwanda’s existing pre-exposure prophylaxis (PrEP) options. According to Dr. Zephanie Nzeyimana, HIV Key Population Strategic Officer at RBC, having lenacapavir in Rwanda is a major step forward in public health as it makes prevention easier than taking daily pills, and it also helps reduce stigma. Rwanda has recorded steady progress in HIV treatment coverage. As of June 2025, more than 229,000 people were receiving antiretroviral therapy, representing a 96.9 percent coverage rate, according to the HIV, STIs and Viral Hepatitis Annual Report 2024/2025. Retention in care has also remained high, with 94 percent of patients staying on treatment after one year. In addition, many patients now receive medicines for three to six months at a time, reducing the need for monthly clinic visits. Children, adolescents still lag behind Gaps remain among children and adolescents. For instance, coverage among children aged 0-14 stands at 75 percent. The report shows that many of those missing from care were never identified early, particularly those born to mothers living with HIV. For adolescents and young adults aged 15-24, some discontinue treatment after starting. Similar patterns are also seen among men aged 25-49, who are less consistent in follow-up care. During the reporting period, 11,162 people were newly enrolled on treatment, while 1,987 who had dropped out were traced and returned to care. However, 3,258 people were newly lost to follow-up, and 1,683 deaths were recorded. Even among those still in care, challenges remain in monitoring. Viral load testing coverage stands at 88 percent, affected by missed appointments and delays in sample collection and processing. Rwanda has already met global HIV targets, with most people living with HIV knowing their status, on treatment, and achieving viral suppression. Health officials now say attention is shifting from expanding access to ensuring continuity of care, especially among children and young people. To address these gaps, RBC and the Ministry of Health have introduced new approaches, including the ATLAS model, being implemented in 30 health facilities. The model is designed to make services more adolescent-friendly and strengthen adherence among young people. Another initiative, LIFT-UP, focuses on identifying children and adolescents who are not yet in care, although its reach is still limited to selected districts. Health workers are also receiving mentorship and training, alongside efforts to strengthen supply systems for paediatric medicines and test kits to avoid stock shortages. Barriers begin early in life According to Dr Gilbert Mbaraga, Medical Manager at AHF Rwanda, children and adolescents continue to lag behind adults in HIV diagnosis, treatment coverage and viral suppression. He explained that the gap begins early. Some HIV-exposed infants miss early infant diagnosis, while others who contract HIV through mother-to-child transmission grow up undiagnosed when they do not show obvious symptoms, leading to delayed treatment. “Some parents avoid testing their children due to fear of discrimination or concerns that their own HIV status could be exposed,” he said. “Adolescents, on their part, often avoid testing due to fear of judgment from peers, family members, or health workers. Health services are designed for adults and may not adequately address adolescents’ needs for privacy, confidentiality, and psychosocial support.” RBC has expanded HIV testing services through voluntary counselling and testing, self-testing, partner notification, and community-based outreach. However, officials say more targeted efforts are needed to reach adolescents and young people. Dr. Mbaraga noted that some children are not informed of their HIV status at the appropriate age, making it difficult for them to understand the need for lifelong medication, which affects consistency in taking treatment. Psychosocial pressures further complicate adherence. Adolescents often face depression, anxiety, stigma, peer pressure, and relationship concerns, all of which can affect engagement in care. Treatment fatigue is also common, especially among those who have been on medication since childhood. The transition from paediatric to adult care services can also lead to loss of follow-up when support systems become less structured, the expert noted. According to Mbaraga, economic and social challenges such as transport costs, food insecurity, school schedules, and limited caregiver support further disrupt clinic visits. Rwanda has prioritised children, adolescents and young people living with HIV through peer-led approaches such as Community Adolescent Treatment Supporters (CATS), alongside psychosocial support and active tracing of those who miss appointments.
