Explore the vast range of titles available.

Background Rwanda has made remarkable progress in scaling up HIV testing, treatment, and healthcare services. Recent data show that 95% of people living with HIV (PLWH) were aware of their status, 97.5% of them are on antiretroviral therapy (ART), and 98% of those who are on treatment have achieved viral suppression. Importantly, growing body of evidence supports the Undetectable = Untransmittable (U = U) concept, affirming that PLWH who maintain an undetectable viral load do not transmit HIV to their sexual partners. This pivotal breakthrough in HIV care has transformed public health strategies and stigma reduction efforts. This study aimed to explore the perspectives of PLWH on the U = U concept in health facilities in Rwanda. Methods An exploratory qualitative study was conducted at three purposively selected health facilities in Rwanda from December 1 to 30, 2023. An interview guide was used to collect data, and data saturation was reached after enrolling 43 PLWH. The data was analyzed using conventional thematic analysis. Results The majority of participants demonstrated good knowledge of HIV transmission, with the U = U concept being particularly well-understood among discordant couples and individuals who have been on treatment for over 10 years. Three themes emerged from the analysis: [ 1 ] comprehensive knowledge of HIV transmission among PLWH; [ 2 ] reasons for disclosing HIV status and linking to care; and [ 3 ] acceptability of the U = U concept. Conclusion Our findings highlight the necessity for broader dissemination of the U = U concept across all PLWH subpopulations. Further research is essential to better understand the challenges faced by PLWH, which is critical for achieving the UNAIDS goal of ending the HIV/AIDS epidemic by 2030.

Background Long-acting injectable antiretroviral therapy (LAI ART) is a new, and innovative approach to HIV treatment, designed to address several challenges, including the adherence issues associated with daily oral ART. This review synthesizes existing literature on the barriers and strategies for implementing LAI ART in the sub-Saharan Africa region, while identifying key knowledge gaps and research priorities. Methods We performed a comprehensive literature search, encompassing electronic databases and grey literature sources. Our review included 18 studies published between 2014 and 2023, focusing on the acceptability, feasibility, effectiveness, and cost-effectiveness of LAI ART in SSA. A narrative synthesis approach was employed for reporting review findings. Results Our review revealed a high demand and acceptability of LAI ART among people living with HIV in SSA, particularly those facing stigma and discrimination. LAI ART can improve adherence, retention, and viral suppression while reducing pill burden and frequent clinic visits. Implementation challenges include lack of regulatory approval, high cost, limited supply chain, health system capacity, trained staff, and cold storage facilities. Further research on safety and efficacy, as well as efforts in advocacy, policy, and community engagement, are needed to ensure accessibility and equity. Conclusion This review highlights key knowledge gaps and research priorities essential for the successful implementation of LAI ART in sub-Saharan Africa. Addressing these gaps such as evaluating long-term outcomes, understanding drug resistance, and exploring the impact on sexual and reproductive health will be critical to ensuring the broader accessibility, effectiveness, and sustainability of LAI ART in the region. Further research on the experiences and preferences of different subgroups, as well as the interaction with other medications and co-infections, is also needed to inform tailored implementation strategies. Clinical trials number Not applicable.

Background In 2010, Rwanda adopted ART for prevention of mother to child transmission of HIV from pregnant women living with HIV during pregnancy and breasfeeding period. This study examines rates of mother-to-child-transmission of HIV at 6–10 weeks postpartum and risk factors for mother-to-child transmission of HIV (MTCT) among HIV infected women on ART during pregnancy and breastfeeding. Methods A cross-sectional survey study was conducted between July 2011–June 2012 among HIV-exposed infants aged 6–10 weeks and their mothers/caregivers. Stratified multi-stage, probability proportional to size and systematic sampling to select a national representative sample of clients. Consenting mothers/caregivers were interviewed on demographic and program interventions. Dry blood spots from HIV-exposed infants were collected for HIV testing using DNA PCR technique. Results are weighted for sample realization. Univariable analysis of socio-demographic and programmatic determinants of early mother-to-child transmission of HIV was conducted. Variables were retained for final multivariable models if they were either at least of marginal significance ( p -value < 0.10) or played a confounding role (the variable had a noticeable impact > 10% change on the effect estimate). Results The study sample was 1639 infants with HIV test results. Twenty-six infants were diagnosed HIV-positive translating to a weighted MTCT estimate of 1.58% (95% CI 1.05–2.37%). Coverage of most elimination of MTCT (EMTCT) program interventions, was above 80, and 90.4% of mother-infant pairs received antiretroviral treatment or prophylaxis. Maternal ART and infant antiretroviral prophylaxis (OR 0.01; 95%CI 0.001–0.17) and maternal age older than 25 years were significantly protective (OR 0.33; 95%CI 0.14–0.78). No disclosure of HIV status, not testing for syphilis during pregnancy and preterm birth were significant risk factors for MTCT. Factors suggesting higher socio-demographic status (flush toilet, mother self-employed) were borderline risk factors for MTCT. Conclusion ART for all women during pregnancy and breastfeeding was associated with the estimated low MTCT rate of 1.58%. Mothers who did not receive a full package of anti-retroviral therapy according to the Rwanda EMTCT protocol, and young and single mothers were at higher risk of MTCT and should be targeted for support in preventing HIV infection.

Background To achieve the ambitious 90–90-90 UNAIDS targets, access to routine viral load (VL) is critical. To measure VL, Rwanda has relied on a national reference laboratory for years. In 2014, a VL testing platform was implemented in a rural District in the Northern Province. Here we analyze the uptake of VL testing, identification of risks for detectable VL (≥1000 copies/ml), and the management of patients with a detectable VL. Methods A retrospective cohort study of patients who started ART between July 2012 and June 2015 and followed until end December 2016. Using descriptive statistics, we describe the VL cascade, from VL uptake to the start of second-line ART in patients diagnosed with virological failure. We estimate predictors of having a detectable VL using logistic regression. Results The uptake of VL testing increased progressively between 2013 and 2016, raising from 25.6% (39/152) in 2013 up to 93.2% (510/547) in 2016.In 2016, 88.5% ( n  = 451) of patients tested, had a suppressed VL. Predictors of having a detectable VL included being male (aOR 2.1; 95%CI 1.12–4.02; p  = 0.02), being a sex worker (aOR 6.4; 95%CI 1.1–36.0; p  = 0.04), having a WHO clinical stage IV when starting ART (aOR 8.8; 95%CI 1.8–43.0; p  < 0.001), having had a previous detectable VL (aOR 7.2; 95%CI 3.5–14.5; p < 0.001), and having had no VL before 2016 (aOR 3.1; 95%CI 1.2–8.1; p = 0.02). Among patients with initial detectable VL between 2013 and 2016, 88% ( n  = 103) had a follow-up VL, of whom 60.2% ( n  = 62) suppressed their VL below 1000 copies/ml. The median time between the initial and follow-up VL was of 12.5 months (IQR: 8.7–19.0). Among patients with confirmed treatment failure, 63.4% ( n  = 26) started second-line ART within the study period. Conclusion VL uptake increased after decentralizing VL testing in rural Rwanda. Virological suppression was high. An individualized follow up of patients at risk of non-suppression and a prompt management of patients with detectable VL may help to achieve and sustain the third global UNAIDS target: virological suppression in 90% of patients on ART.

To reduce HIV/AIDS related mortality of children, adherence to antiretroviral treatment (ART) is critical in the treatment of HIV positive children. However, little is known about the association between ART adherence and different orphan status. The aims of this study were to assess the ART adherence and identify whether different orphan status was associated with the child's adherence. A total of 717 HIV positive children and the same number of caregivers participated in this cross-sectional study. Children's adherence rate was measured using a pill count method and those who took 85% or more of the prescribed doses were defined as adherent. To collect data about adherence related factors, we also interviewed caregivers using a structured questionnaire. Of all children (N = 717), participants from each orphan category (double orphan, maternal orphan, paternal orphan, non-orphan) were 346, 89, 169, and 113, respectively. ART non-adherence rate of each orphan category was 59.3%, 44.9%, 46.7%, and 49.7%, respectively. The multivariate analysis indicated that maternal orphans (AOR 0.31, 95% CI 0.12-0.80), paternal orphans (AOR 0.35, 95% CI 0.14-0.89), and non-orphans (AOR 0.45, 95% CI 0.21-0.99) were less likely to be non-adherent compared to double orphans. Double orphans who had a sibling as a caregiver were more likely to be non-adherent. The first mean CD4 count prior to initiating treatment was 520, 601, 599, and 844 (cells/ml), respectively (p<0.001). Their mean age at sero-status detection was 5.9, 5.3, 4.8, and 3.9 (year old), respectively (p<0.001). Double orphans were at highest risk of ART non-adherence and especially those who had a sibling as a caregiver had high risk. They were also in danger of initiating ART at an older age and at a later stage of HIV/AIDS compared with other orphan categories. Double orphans need more attention to the promote child's adherence to ART.

Introduction Every year, approximately 260,000 children are infected with HIV in low‐ and middle‐income countries. The timely initiation and high level of maintenance of antiretroviral therapy (ART) are crucial to reducing the suffering of HIV‐positive children. We need to develop a better understanding of the background of children's ART non‐adherence because it is not well understood. The purpose of this study is to explore the background related to ART non‐adherence, specifically in relation to the orphan status of children in Kigali, Rwanda. Methods We conducted 19 focus group discussions with a total of 121 caregivers of HIV‐positive children in Kigali. The primary data for analysis were verbatim transcripts and socio‐demographic data. A content analysis was performed for qualitative data analysis and interpretation. Results The study found several contextual factors that influenced non‐adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans. The factors promoting adherence also were unique to each orphan status, such as the positive attitude about disclosing serostatus to the child by double orphans’ caregivers, and feelings of guilt about the child's condition among non‐orphaned caregivers. Conclusions Knowledge of orphan status is essential to elucidate the factors influencing ART adherence among HIV‐positive children. In this qualitative study, we identified the orphan‐related contextual factors that influenced ART adherence. Understanding the social context is important in dealing with the challenges to ART adherence among HIV‐positive children.

In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodeficiency virus (HIV) disease within a public health approach. Recent data suggest that more than a third of people starting antiretroviral therapy (ART) do so with advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following a period of disengagement from care. These guidelines recommend a standardized package of care for adults, adolescents, and children, based on the leading causes of morbidity and mortality: tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia. A package of targeted interventions to reduce mortality and morbidity was recommended, based on results of 2 recent randomized trials that both showed a mortality reduction associated with delivery of a simplified intervention package. Taking these results and existing recommendations into consideration, WHO recommends that a package of care be offered to those presenting with advanced HIV disease; depending on age and CD4 cell count, the package may include opportunistic infection screening and prophylaxis, including fluconazole preemptive therapy for those who are cryptococcal antigen positive and without evidence of meningitis. Rapid ART initiation and intensified adherence interventions should also be proposed to everyone presenting with advanced HIV disease.

Introduction Aiming to reach UNAIDS 90‐90‐90 targets, nearly all sub‐Saharan African countries have expanded antiretroviral therapy (ART) to all people living with HIV (PLWH) (Treat All). Few published data exist on viral load testing and viral suppression under Treat All in this region. We assessed proportions of patients with available viral load test results and who were virally suppressed, as well as factors associated with viral suppression, among PLWH in 10 Rwandan health centres after Treat All implementation. Methods Cross‐sectional study during 2018 of adults (≥15 years) engaged in HIV care at 10 Rwandan health centres. Outcomes were being on ART (available ART initiation date in the study database, with no ART discontinuation prior to 1 January 2018), retained on ART (≥2 post‐ART health centre visits ≥90 days apart during 2018), available viral load test results (viral load measured in 2018 and available in study database) and virally suppressed (most recent 2018 viral load <200 copies/mL). We used modified Poisson regression models accounting for clustering by health centre to determine factors associated with being virally suppressed. Results Of 12,238 patients, 7050 (58%) were female and 1028 (8%) were aged 15 to 24 years. Nearly all patients (11,933; 97%) were on ART, of whom 11,198 (94%) were retained on ART. Among patients retained on ART, 10,200 (91%) had available viral load results; of these 9331 (91%) were virally suppressed. Viral suppression was less likely among patients aged 15 to 24 compared to >49 years (adjusted prevalence ratio (aPR): 0.83, 95% CI 0.76 to 0.90 and those with pre‐ART CD4 counts of <200 compared to ≥500 cells/mm3 (aPR: 0.92, 95% CI 0.90 to 0.93). There was no statistically significant difference in viral suppression among patients who entered after Treat All implementation compared to those who enrolled before 2010 (aPR 0.98, 95% CI 0.94 to 1.03). Conclusions In this large cohort of Rwandan PLWH receiving HIV care after Treat All implementation, patients in study health centres have surpassed the third UNAIDS 90‐90‐90 target. To ensure all PLWH fully benefit from ART, additional efforts should focus on improving ART adherence among younger persons.

In 2010, Rwanda adopted ART for prevention of mother to child transmission of HIV from pregnant women living with HIV during pregnancy and breasfeeding period. This study examines rates of mother-to-child-transmission of HIV at 6-10 weeks postpartum and risk factors for mother-to-child transmission of HIV (MTCT) among HIV infected women on ART during pregnancy and breastfeeding. A cross-sectional survey study was conducted between July 2011-June 2012 among HIV-exposed infants aged 6-10 weeks and their mothers/caregivers. Stratified multi-stage, probability proportional to size and systematic sampling to select a national representative sample of clients. Consenting mothers/caregivers were interviewed on demographic and program interventions. Dry blood spots from HIV-exposed infants were collected for HIV testing using DNA PCR technique. Results are weighted for sample realization. Univariable analysis of socio-demographic and programmatic determinants of early mother-to-child transmission of HIV was conducted. Variables were retained for final multivariable models if they were either at least of marginal significance (p-value < 0.10) or played a confounding role (the variable had a noticeable impact > 10% change on the effect estimate). The study sample was 1639 infants with HIV test results. Twenty-six infants were diagnosed HIV-positive translating to a weighted MTCT estimate of 1.58% (95% CI 1.05-2.37%). Coverage of most elimination of MTCT (EMTCT) program interventions, was above 80, and 90.4% of mother-infant pairs received antiretroviral treatment or prophylaxis. Maternal ART and infant antiretroviral prophylaxis (OR 0.01; 95%CI 0.001-0.17) and maternal age older than 25 years were significantly protective (OR 0.33; 95%CI 0.14-0.78). No disclosure of HIV status, not testing for syphilis during pregnancy and preterm birth were significant risk factors for MTCT. Factors suggesting higher socio-demographic status (flush toilet, mother self-employed) were borderline risk factors for MTCT. ART for all women during pregnancy and breastfeeding was associated with the estimated low MTCT rate of 1.58%. Mothers who did not receive a full package of anti-retroviral therapy according to the Rwanda EMTCT protocol, and young and single mothers were at higher risk of MTCT and should be targeted for support in preventing HIV infection.

Introduction Nearly all countries in sub‐Saharan Africa have adopted policies to provide antiretroviral therapy (ART) to all persons living with HIV (Treat All), though HIV care outcomes of these programmes are not well‐described. We estimated changes in ART initiation and retention in care following Treat All implementation in Rwanda in July 2016. Methods We conducted an interrupted time series analysis of adults enrolling in HIV care at ten Rwandan health centres from July 2014 to September 2017. Using segmented linear regression, we assessed changes in levels and trends of 30‐day ART initiation and six‐month retention in care before and after Treat All implementation. We compared modelled outcomes with counterfactual estimates calculated by extrapolating baseline trends. Modified Poisson regression models identified predictors of outcomes among patients enrolling after Treat All implementation. Results Among 2885 patients, 1803 (62.5%) enrolled in care before and 1082 (37.5%) after Treat All implementation. Immediately after Treat All implementation, there was a 31.3 percentage point increase in the predicted probability of 30‐day ART initiation (95% CI 15.5, 47.2), with a subsequent increase of 1.1 percentage points per month (95% CI 0.1, 2.1). At the end of the study period, 30‐day ART initiation was 47.8 percentage points (95% CI 8.1, 87.8) above what would have been expected under the pre‐Treat All trend. For six‐month retention, neither the immediate change nor monthly trend after Treat All were statistically significant. While 30‐day ART initiation and six‐month retention were less likely among patients 15 to 24 versus >24 years, the predicted probability of both outcomes increased significantly for younger patients in each month after Treat All implementation. Conclusions Implementation of Treat All in Rwanda was associated with a substantial increase in timely ART initiation without negatively impacting care retention. These early findings support Treat All as a strategy to help achieve global HIV targets.