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Female sex workers (FSW) are at increased risk of HIV and other STI. In addition, the burden of HIV infection among this group is much higher when compared to adult females in the general population. Estimating the number of FSW helps HIV/STI prevention through program design, planning, and implementation. The aims of this study are to provide the most up to date national population size estimates (PSE) and geographical distribution of female sex workers and sexually exploited minors in Rwanda. Having population size estimates of the HIV-mostly affected population, FSW in this case provides the basis for determining the denominators to assess HIV program performance towards national and global targets of controlling the HIV epidemic among the FSW population. Data were collected from May 8th to June 24th, 2023, across 10 study sites countywide. Privatized network sampling (PNS) was used, which is a population size estimation method that uses the network information collected within a bio-behavioral survey (BBS) that used respondent-driven sampling (RDS). To estimate the FSW and sexually exploited minors' population size, three PNS estimators were used: Cross-Sample, Cross-Alter, and Cross-Network. The national-level FSW population size was estimated at 98,587 (95% CI: 82,978-114,196), corresponding to 2.3% of the total adult female population aged 15 years and above in Rwanda. We estimated that in the City of Kigali, 5.3%, in the West Province, 2.2%, in the East and South province, 1.7% each, and in the North province 1.6% of adult female population 15 years of age and older who were FSW. This was the first time that PNS was implemented as a PSE method in Rwanda, adding to the emerging tools that we have in the hard-to-reach PSE field. The PSE provides fundamental information to design, plan, and implement programs for FSW at the provincial level in Rwanda. Furthermore, these estimates will help to generate positive policy changes and to advocate for resources that will help in the effort to achieve a sustained HIV epidemic control in the country.

Introduction Africa was threatened by the coronavirus disease 2019 (COVID-19) due to the limited health care infrastructure. Rwanda has consistently used non-pharmaceutical strategies, such as lockdown, curfew, and enforcement of prevention measures to control the spread of COVID-19. Despite the mitigation measures taken, the country has faced a series of outbreaks in 2020 and 2021. In this paper, we investigate the nature of epidemic phenomena in Rwanda and the impact of imported cases on the spread of COVID-19 using endemic-epidemic spatio-temporal models. Our study provides a framework for understanding the dynamics of the epidemic in Rwanda and monitoring its phenomena to inform public health decision-makers for timely and targeted interventions. Results The findings provide insights into the effects of lockdown and imported infections in Rwanda’s COVID-19 outbreaks. The findings showed that imported infections are dominated by locally transmitted cases. The high incidence was predominant in urban areas and at the borders of Rwanda with its neighboring countries. The inter-district spread of COVID-19 was very limited due to mitigation measures taken in Rwanda. Conclusion The study recommends using evidence-based decisions in the management of epidemics and integrating statistical models in the analytics component of the health information system.

A Rift Valley fever epizootic affected livestock in Rwanda during March-October 2022. We confirmed 3,112 infections with the virus, including 1,342 cases, 1,254 abortions, and 516 deaths among cattle, goats, and sheep. We recommend a One Health strategy for investigations and response to protect animal and human health.

Background and Objective: Stunting remains a critical public health concern affecting child growth and development, particularly among children under two years of age in low- and middle-income countries, including Rwanda. This study investigates spatiotemporal trends in stunting prevalence from 2020 to 2024 at the sector level using national surveillance data. Methods: To capture regional disparities and temporal trends, we used hierarchical Bayesian spatiotemporal models, which accounted for spatial structure, temporal correlations, and interactions, to estimate stunting prevalence across districts and sectors over time. Results: Between 2020 and 2024, the national prevalence of stunting among children under two years decreased from 33.1% to 21.7%, representing a 34.4% change. Three districts, Kamonyi, Nyarugenge, and Ngoma, achieved reductions of >70%, whereas Rubavu, Nyabihu, and Nyaruguru saw minimal change (14–15%). By 2024, several sectors in Kicukiro, Nyanza, Nyarugenge, and Kirehe had reduced levels of stunting below the national target of 19%. Conclusions: Despite considerable gains, significant geographical differences persist in the stunting prevalence of children under two, underscoring the need for targeted, decentralized interventions to mitigate and eliminate this in lagging areas.

Background HIV remains a major public health concern globally, and 85% of adolescents with HIV (AWH) live in Sub-Saharan Africa (SSA). Despite advances in treatment and prevention efforts, adolescents continue to be disproportionately affected by HIV and are a group with poor adherence to antiretroviral medication. We identified phenotypes of successful living among adolescents with HIV in Rwanda. Methods A multi-stage stratified random sampling was used to collect data from 300 AWH using a validated and piloted questionnaire from four provinces and Kigali City in Rwanda. Data were collected in August 2023 and were analyzed using latent profile analysis (LPA). The following variables were computed to measure their associations and determine the latent profiles (or phenotypes) of successful living: viral load, number of sex partners in a lifetime, condom use during sex, adherence to HIV antiretroviral therapy, HIV stigma, depressive symptoms, state of hope, self-esteem, resilience, disclosure, HIV quality of life, and perceived social support. Results The two distinct profiles of successful living among adolescents with HIV were identified through LPA: 46% of adolescents struggled to live with HIV (the first profile) while 54% of adolescents lived successfully with HIV (the second profile). There are several factors associated with successful living among AWH. Successful living was positively associated with spirituality, residing with family members, a stable home environment, psychological well-being, social support, and acquiring HIV through vertical transmission. The adherence to ART, HIV-related stigma, levels of depression, hope, self-esteem, resilience, availability of social support, and patterns of disclosure of HIV status are determinants of adolescents’ experiences of living with HIV. Additionally, adolescents tend to struggle to live with HIV in late adolescence, especially when the factors associated with successful living are not met. Conclusions This study identified two profiles of Successful Living among AWH. Our results suggest developing profile-oriented, tailored interventions to improve the quality of life and health outcomes of AWH.

Background The core vector control tools used to reduce malaria prevalence are currently long-lasting insecticidal nets (LLINs), and indoor residual spraying (IRS). These interventions are hindered by insecticide resistance and behavioural adaptation by malaria vectors. Thus, for effective interruption of malaria transmission, there is a need to develop novel vector control interventions and technologies to address the above challenges. Larviciding using drones was experimented as an innovative tool that could complement existing indoor interventions to control malaria. Methods A non-randomized larviciding trial was carried out in irrigated rice fields in sub-urban Kigali, Rwanda. Potential mosquito larval habitats in study sites were mapped and subsequently sprayed using multirotor drones. Application of Bacillus thuringiensis var. israelensis (Bti) (Vectobac ® WDG) was followed by entomological surveys that were performed every two weeks over a ten-month period. Sampling of mosquito larvae was done with dippers while adult mosquitoes were collected using CDC miniature light traps (CDC-LT) and pyrethrum spraying collection (PSC) methods. Malaria cases were routinely monitored through community health workers in villages surrounding the study sites. Results The abundance of all-species mosquito larvae, Anopheles larvae and all-species pupae declined by 68.1%, 74.6% and 99.6%, respectively. Larval density was reduced by 93.3% for total larvae, 95.3% for the Anopheles larvae and 61.9% for pupae. The total adult mosquitoes and Anopheles gambiae sensu lato collected using CDC-Light trap declined by 60.6% and 80% respectively. Malaria incidence also declined significantly between intervention and control sites (U = 20, z = − 2.268, p = 0.023). Conclusions The larviciding using drone technology implemented in Rwanda demonstrated a substantial reduction in abundance and density of mosquito larvae and, concomitant decline in adult mosquito populations and malaria incidences in villages contingent to the treatment sites. The scaling up of larval source management (LSM) has to be integrated in malaria programmes in targeted areas of malaria transmission in order to enhance the gains in malaria control.

IntroductionCommunity health workers (CHWs) are critical to healthcare delivery in low-resource settings but often lack formal clinical training, limiting their decision-making. Large language models (LLMs) could provide real-time, context-specific support to improve referrals and management plans. This study aims to evaluate the potential utility of LLMs in assisting CHW decision-making in Rwanda.Methods and analysisThis is a prospective, observational study conducted in Nyabihu and Musanze districts, Rwanda. Audio recordings of CHW-patient consultations will be transcribed and analysed by an LLM to generate referral decisions, differential diagnoses and management plans. These outputs, alongside CHW decisions, will be evaluated against a clinical expert panel’s consensus. The primary outcome is the appropriateness of referral decisions. Secondary outcomes include diagnostic accuracy, management plan quality, and patient and user perceptions to ambient recording of consultations. Sample size is set at 800 consultations (400 per district), powered to detect a 15–20 percentage point improvement in referral appropriateness.Ethics and disseminationEthical approval has been obtained from the Rwandan National Ethics Committee (RNEC) (Ref number: RNEC 853/2025) in June 2025, recruitment started in July 2025 and results are expected in late 2025. Results will be disseminated via stakeholder meetings, academic conferences and peer-reviewed publication.Trial registration numberPACTR202504601308784.

Background Men who have sex with men (MSM) are a key population group disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. In Rwanda, the HIV epidemic remains a significant public health concern, and understanding the burden of HIV and hepatitis B and C coinfections among MSM is crucial for designing effective prevention and control strategies. This study aims to determine the prevalence of HIV, hepatitis B, and hepatitis C infections among MSM in Rwanda and identify correlates associated with HIV infection within this population. Methods We used respondent-driven sampling (RDS) to recruit participants between November and December 2021. A face-to-face, structured questionnaire was administered. Testing for HIV infection followed the national algorithm using two rapid tests: Alere Combo and STAT PAK as the first and second screening tests, respectively. Hepatitis B surface antigen (HBsAg) and anti-HCV tests were performed. All statistics were adjusted for RDS design, and a multivariable logistic regression model was constructed to identify factors associated with HIV infection. Results The prevalence of HIV among MSM was 6·9% (95% CI: 5·5–8·6), and among HIV-positive MSM, 12·9% (95% CI: 5·5–27·3) were recently infected. The prevalence of hepatitis B and C was 4·2% (95% CI: 3·0–5·7) and 0·7% (95% CI: 0·4–1·2), respectively. HIV and hepatitis B virus coinfection was 0·5% (95% CI: 0·2–1·1), whereas HIV and hepatitis C coinfection was 0·1% (95% CI: 0·0–0·5), and no coinfection for all three viruses was observed. MSM groups with an increased risk of HIV infection included those who ever suffered violence or abuse because of having sex with other men (AOR: 3·42; 95% CI: 1·87–6·25), those who refused to answer the question asking about ‘ever been paid money, goods, or services for sex’ (AOR: 10·4; 95% CI: 3·30–32·84), and those not consistently using condoms (AOR: 3·15; 95% CI: 1·31–7·60). Conclusion The findings suggest more targeted prevention and treatment approaches and underscore the importance of addressing structural and behavioral factors contributing to HIV vulnerability, setting interventions to reduce violence and abuse against MSM, promoting safe and consensual sexual practices, and expanding access to HIV prevention tools such as condoms and preexposure prophylaxis (PrEP).

HIV treatment guidelines recommend that all people living with HIV (PLWH) initiate antiretroviral therapy (ART) as soon as possible after diagnosis (Treat All). As Treat All is more widely implemented, an increasing proportion of PLWH are likely to initiate ART when they are asymptomatic, and they may view the relative benefits and risks of ART differently than those initiating at more advanced disease stages. To date, patient perspectives of initiating care under Treat All in sub-Saharan Africa have not been well described. From September 2018 to March 2019, we conducted individual, semi-structured, qualitative interviews with 37 patients receiving HIV care in two health centers in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive thematic analysis approach to describe perceived barriers to, facilitators of and acceptability of initiating and adhering to ART rapidly under Treat All. Of 37 participants, 27 were women and the median age was 31 years. Participants described feeling traumatized and overwhelmed by their HIV diagnosis, resulting in difficulty accepting their HIV status. Most were prescribed ART soon after diagnosis, yet fear of lifelong medication and severe side effects in the immediate period after initiating ART led to challenges adhering to therapy. Moreover, because many PLWH initiated ART while healthy, taking medications and attending appointments were visible signals of HIV status and highly stigmatizing. Nonetheless, many participants expressed enthusiasm for Treat All as a program that improved health as well as health equity. For newly-diagnosed PLWH in Rwanda, initiating ART rapidly under Treat All presents logistical and emotional challenges despite the perceived benefits. Our findings suggest that optimizing early engagement in HIV care under Treat All requires early and ongoing intervention to reduce trauma and stigma, and promote both individual and community benefits of ART.

Background Rwanda has made significant strides in malaria control. This study reviews malaria epidemiology and control strategies in Rwanda from 2018 to 2023, documenting their impact, persistent gaps and emerging challenges. Methods Data on Rwanda’s malaria context from 2018 to 2023 were obtained through a literature review of peer-reviewed articles and grey literature, including annual reports from the malaria programmes, partners, the African Union, and the World Health Organization (WHO). Specific keywords used for the search included “malaria”, “Rwanda”, “case management”, “control”, “treatment”, and “prevention”. Moreover, epidemiological data for this period was extracted from the Health Management Information System (HMIS). Data analysis was done using R & R-Studio, ANOVA to assess the statistical significance (P < 0.05) of observed trends and T-test to compare the focal and blanket IRS techniques. Results/Discussion Between 2018 and 2023, all malaria indicators showed improvement. Malaria incidence dropped from 345 to 40 cases per 1000 persons (P = 0.00292), the severe malaria rate decreased from 112 to 10/100,000 persons (P = 0.018), and the mortality rate fell from 2.72 to 0.258 deaths /100,000 persons (P = 0.00617). Among children under 5 years of age, incidence decreased significantly from 331 to 52/1,000 persons (P = 0.00123), the severe malaria rate dropped from 214 to 29/100,000 persons (P = 0.00399), and mortality declined from 5 to 0.453/100,000 persons (P = 0.00504). Over the same period, key malaria interventions expanded. The proportion of cases treated by CHWs increased significantly, improving access to early diagnosis and treatment (from 13 to 59%), and the new generations of ITNs (PBO and dual-active ingredient nets) were deployed in 9 districts. Since 2019, a blanket spraying technique has been adopted in 12 IRS districts replacing the focal spraying technique contributing to the significant decrease of malaria incidence from 2019 to 2023 (P = 0.0025). However, new challenges have emerged, including the rise of the K13 R561H mutation associated with artemisinin resistance, the spread of insecticide resistance, and limited intervention coverage due to resource constraints. Conclusion To sustain the progress achieved, it is essential to intensify malaria control efforts, foster compliance with intervention strategies, enhance surveillance systems for timely and effective responses, and secure long-term funding to sustain these measures.