Rwanda

Stepping into the Remera Health Centre in Kigali, the Desert AIDS Project (DAP) delegation visited one of the 552 integrated health centres in Rwanda. The clinic offers everything from primary care to clinical care for all ages, as well as HIV services.

The head of the centre, Emile Musabyimana, led the group around the facility, which includes a laboratory where HIV, viral load and tuberculosis testing are carried out. He is particularly proud that Remera has adopted the test and treat approach, which means that anyone who tests positive for HIV is immediately offered treatment.

The Remera Health Centre serves about 3000 people living with HIV, of which 2400 are virally suppressed. The clinic monitors patients on a monthly basis until their viral loads drop to undetectable levels.

Established by a group of volunteers in 1984, the DAP provides HIV prevention, treatment and care services to people living with and affected by HIV across the Palm Springs, California, area. It has expanded its primary care facility to include a dental clinic and affordable housing.

The delegation, in Kigali for the International Conference on AIDS and STIs in Africa (ICASA), discussed some of the challenges the Remera centre faces. Mr Musabyimana explained that too few young people come to the clinic.

“We need to address the issues of why they don’t come and get tested,” he said. “And when they do know their HIV-positive status, they don’t always stay on treatment.”

As a result, the centre organized an informal chat with young people living with HIV with the delegation.

“A lot of these kids were born with HIV and a lot of them are stigmatized and so they’re fighting it and fighting through it,” said Patrick Jordan, DAP Vice-Chair. He added, “To see them in their valiant efforts and how strong they are is inspiring.”

David Brinkman, DAP Chief Executive Officer, couldn’t agree more. He applauded the health centre’s work as well as Rwanda’s low HIV prevalence rate compared to neighbouring countries in the region.

“We really have to acknowledge what Rwanda is doing,” he said. “People on the ground have all the knowledge they need, it’s now about resources so that when we combine knowledge and resources, we will end the epidemic by 2030.”

Over the past year, a partnership between DAP and UNAIDS has been growing, with the idea of joining forces to support grass-roots and community-led HIV efforts worldwide.

Momentum for Universal Health Coverage (UHC) in Africa is building and many African countries have already integrated UHC into their national health strategies. But with 11 million Africans pushed into extreme poverty each year because of out-of-pocket health expenses, how can Africa achieve UHC which delivers a quality package of care for people living in Africa?

The UHC debate was buzzing in Rwanda’s capital Kigali this week during one of the largest health gatherings in Africa, the Africa Health Agenda International conference 2019.  Co-hosted by the Ministry of Health of Rwanda and the African Medical and Research Foundation (Amref Health Africa), 1500 health leaders shared new ideas and home-grown solutions to the continent’s most pressing health challenges.

Participants discussed the need for countries to embrace the concept of UHC and do their utmost to make it work. They stressed that good health allows children to learn and adults to contribute to societies and the economy. They also underscored that it can allow people to emerge from poverty and provides the basis for long-term economic security, essential for the future of the continent.

Host country President, Paul Kagame was awarded the honour of excellence in recognition of his political leadership on UHC. In a tweet he thanked Amref saying, “We owe this progress to partners like you who have joined forces with us in our journey to deliver a dignified and healthy life for all Rwandans.” The Minister of Health of Ethiopia also received an award for Ethiopia’s work in promoting primary health care.

Ensuring that everyone has access to basic health services is a challenge and the key to the success of UHC will be ensuring that the quality of services is good enough to improve the health of the people who access them.

“We need to track the impact of UHC,” said Michel Sidibé, co-moderating a high-level ministerial panel. “Coverage is not enough, we need to be delivering quality, affordable, accessible services to all. The ultimate measure of success for UHC will be whether the poorest, the marginalized and the most vulnerable people are able to benefit.”

During the conference Mr Sidibé participated in a townhall with young people. He spoke to them about their meaningful engagement in the UHC process saying that young people need to ‘claim and own the space.’ He also talked to civil society groups about the remarkable progress towards achieving the UNAIDS 90-90-90 treatment targets across Africa and of the critical need of their continued engagement on HIV within UHC.

The first ever United Nations High-Level Meeting on Universal Health Coverage will take place on 23 September 2019 during the United Nations General Assembly under the theme ‘Universal Health Coverage: Moving Together to Build a Healthier World.’

African heads of state and government have backed a report from AIDS Watch Africa that welcomed the recently adopted Political Declaration on Ending AIDS and recommended its inclusion in national strategic plans for the AIDS response.

At the 27th African Union summit, held in Kigali, Rwanda, leaders called on Member States to explore innovative mechanisms to increase the allocation of domestic financing for health, while underscoring the continuing importance of global solidarity to respond to HIV, tuberculosis and malaria.

Leaders also stressed the importance of strengthening Africa’s pharmaceutical sector to promote public health and development.

In 2014 in Rwanda, more than 95% of pregnant women living with HIV had access to antiretroviral medicines to prevent the transmission of HIV from mother to child. As a result, the country had fewer than 500 new infections among children last year, paving the way to achieving an AIDS-free generation. The incidence rate for HIV is estimated to be a stable and low 0.11%.

During a visit to Rwanda on 9 and 10 December, UNAIDS Executive Director Michel Sidibé celebrated the country’s achievements and praised President Paul Kagame on his government’s leadership in the continental AIDS response.

Mr Sidibé called on Rwanda to sustain the gains made in health and development and urged the country to keep moving towards sustainable financing for health and HIV.

He also met with the Minister of Health, the Minister of Foreign Affairs and Cooperation, the First Lady and civil society organizations. Mr Sidibé stressed the major role that civil society has to play in advocating for those being left behind in the AIDS response and in pushing for social justice and transformation. Civil society representatives highlighted that access to services for all, including key populations, has been ensured in Rwanda, although stigma and discrimination remain a challenge.

The importance of meaningful community engagement for health and development was further demonstrated during a visit to the Millennium Village Project in Mayange, 40 kilometres south of the capital. It is one of 14 clusters of Millennium Villages that operate across sub-Saharan Africa, serving the poorest and most remote communities in the region. Mayange has three health facilities: a health centre and two health posts.

Mr Sidibé visited the Mayange health centre, which uses an integrated approach to prevent new HIV infections and promote sexual and reproductive health services and family planning. No babies have been born with HIV in the Mayange health centre since 2013, showing that the elimination of mother-to-child transmission of HIV is within reach in Rwanda. Mr Sidibé congratulated the health centre and the local leaders, adding that change is possible with leadership, commitment and passion.

Mr Sidibé also participated in the signing ceremony of the Paris Declaration to Fast-Track the HIV response in cities, which took place at Kigali City Hall on 10 December. The Mayor of Kigali, Fidele Ndayisaba, committed to accelerate the response in the capital and to lead, guide and support other urban areas in doing so. The cities initiative will help translate commitments to Fast-Track the HIV response into targeted actions and rapid results through a focus on location and population.

Oral pre-exposure HIV prophylaxis (PrEP) has been shown to be up to 90% effective in preventing HIV infection among people who take it consistently. However, the United States of America is the only country in which PrEP is licensed and recommended for use within HIV prevention programmes. 

In order to find ways to bridge the gaps between evidence and policy-making processes, UNAIDS, AVAC and WHO organized a meeting during the 2014 HIV Research for Prevention (HIV R4P) conference, which is taking place from 28 to 31 October in Cape Town, South Africa. HIV R4P is the world’s first scientific meeting dedicated exclusively to biomedical HIV prevention research.

Participants

The meeting brought together representatives of ministries of health and national AIDS councils from Kenya, Mozambique, South Africa, Uganda and Zimbabwe, PrEP researchers and participants from research and demonstration sites where PrEP is currently being delivered, funders and drug manufacturers, and HIV activists.

Key messages

• PrEP is being used in several demonstration projects across eastern and southern Africa, covering a wide range of populations, including serodiscordant couples in Kenya and Uganda, sex workers in Zimbabwe and men who have sex with men in Kenya and South Africa.
• In order to be used more widely, PrEP must be part of a comprehensive prevention strategy with associated milestones and success indicators that have been defined with policy-makers. The Kenyan Prevention Roadmap already includes the possibility of PrEP.
• Costs and cost-effectiveness models remain key, as are the selection of populations for which PrEP should be offered and the choice of an appropriate delivery model. The Sisters clinics, which provide a dedicated service for sex workers in Zimbabwe, are acceptable to many sex workers and fit within a government strategy.
• The early stopping of the PROUD PrEP study demonstrates that within the sexual health services of the United Kingdom of Great Britain and Northern Ireland there is a strong demand for PrEP and that it is feasible to identify people at greatest risk.
• Demand is now beginning to grow in African communities and needs to be stimulated among those who would most benefit and would be most likely to use PrEP.
• Policy-makers in health and other government departments need more information on PrEP presented in a way that they can use, as well as opportunities to discuss their specific concerns, for example on PrEP safety studies or measures to improve adherence.
• More needs to be understood about the costing of PrEP. This demands greater understanding of who would use PrEP, how they would use it and where they would access it.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.