Five things, including the power of good leadership, are behind Rwanda’s remarkable progress toward achieving HIV epidemic control, particularly in attaining high levels of linkage to treatment and viral load suppression among people living with HIV.
Dr Sabin Nsanzimana, the Director-General of Rwanda Biomedical Centre (RBC), noted this as he explained the new data released Wednesday, during an interview with The New Times on Thursday.
Results from Rwanda Population-based HIV Impact Assessment (RPHIA) show that 76 per cent of all HIV-positive adults, including almost 80 per cent of HIV-positive women, achieved viral load suppression, a widely used measure of effective HIV treatment in a population.
Viral load is the term used to describe the amount of HIV in the blood of an HIV positive person.
This surpasses the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 73 per cent by 2020.
HIV is a virus that damages the immune system, increasing the risk and impact of other infections and diseases, and can especially lead to AIDS.
Preliminary survey findings reflect the degree to which Rwanda’s national HIV programmes and policies contributed significantly towards reducing new infections and ensuring people living with the virus are linked to and sustained on its treatment.
First, Nsanzimana said, everything started immediately after the 1994 Genocide against the Tutsi.
At the time, he said, HIV/AIDS was at its peak in sub-Saharan Africa and was killing many people yet there were no drugs.
Nsanzimana said: “It was a catastrophic situation for the entire sub-Saharan Africa as regards the HIV epidemic. In Rwanda, it was even worse because there was even a Genocide that saw more than one million Tutsi killed by fellow countrymen and [spreading] HIV was used as a weapon of war, with 250 girls and women raped.”
“The priority of the government of Rwanda was HIV. I recall President Paul Kagame declaring that HIV was going to be a national priority, something that certainly led to this progress today.
I often call this [prioritization] the power of good leadership to make things happen in a country that had totally collapsed. Where there is a will, everything else will be possible.”
Nsanzimana added the role of proper use of resources and partnerships.
Initially, donor resources that all countries received were almost the same and Rwanda being a small country never got so much financial aid but “how the resources were used here was different.”
“There was this principle of using fewer resources to achieve more and in a more comprehensive manner. Money was not going into HIV, the virus, but it would go into the building of a strong national health system. HIV resources were used to put up laboratories, buy ambulances, maternity wards, data centres used during epidemics, and so on.”
This was something very important because, Nsanzimana said, the integration of services using HIV resources has built a better response to epidemics.
Third, Nsanzimana explained that data-driven policies and intervention helped “us spend scarce financial resources where most needed for better results.”
Previously, health officials planned without precision data but things changed when planning and implementation was guided by facts.
“In the beginning, people would spend money on things with little or no impact but with the research that we did, we realized that if, for example, you spend one dollar here, the impact will be five times greater here. That focused intervention or intervention guided by evidence got us far.”
Coordination of partners was also crucial, he said. This too, he said, came in handy as there was a time in the past when there were 150 international NGO partners in the country and 150 patients “on our anti-retroviral treatment.”
“That was almost one NGO for one patient. This happened at the beginning, but later, the country decided that our international partners should really channel resources where problems are. At the time, all these partners were based and operating only in the city of Kigali.
“Then several were dispatched to rural areas to go and work and, they were no longer bringing their own agenda on HIV but they found and worked along the existing national plan and strategy against HIV. Some refused this and left the country but we remained with those who were committed to support us.”
This, he explained, had a big impact in terms of accountability too as the international partners were also accountable and this resulted in more efficiency.
The driver of everything, he said, has been leadership and accountability which demanded for performance indicators.
From October 2018-March 2019, RPHIA reached over 11,000 households across the country, surveying more than 30,000 adults aged 15-64 years, and over 9,000 young adolescents aged 10-14 years.
The survey provided home-based HIV testing and counseling services, with return of results and linkage to care for those who tested HIV-positive.
The key results released Wednesday include information on the per centage of people living with HIV (prevalence), the number of new HIV infections occurring each year (incidence), and the per centage of people with low levels of virus in their blood (viral load suppression), described by age, sex, and geographic variation.
The HIV prevalence among adults, aged 15-49 years, was 2.6% and 3% among those aged 15-64 years indicating that approximately 210,200 adults in Rwanda were living with HIV.
It was found that HIV prevalence was higher in women (3.7%) than men (2.2%) and HIV prevalence was 1.9 times higher in urban areas compared to rural areas.
The annual incidence of HIV among adults was 0.08%, corresponding to approximately 5,400 new cases of HIV per year in Rwanda.
Among all adults living with HIV, 76% had suppressed viral loads – 79.1% among women and 70.5% among men.
In relation to UNAIDS 90-90-90 targets, when combining self-reported and laboratory data, results indicated: 83.8% of adults living with HIV were aware of their status, based on self-reporting or the detection of antiretrovirals (ARVs) in participants’ blood samples.
Of adults who knew their status, 97.5% were on ART, based on self-reporting or the detection of ARVs; and of adults who had detectable ARVs or reported current use of ARVs, 90.1% had Viral Load Suppression, literally, suppressing or reducing the function and replication of a virus.