Table 14. Baseline and targets for HIV/AIDS
Combat HIV/AIDS, Malaria, TB, and other diseases
Target 6A: The health sector will contribute to the national efforts to
halt the spread of HIV and AIDS by 2015 through education of individuals and families in every village (Umudugudu) about HIV/AIDS, providing motivation for counseling, distribution of condoms, and making sure that all patients with HIV, AIDS, or tuberculosis receive and adhere to treatment (DOTS for TB) and support.
Target 6B: The health sector will assist the MOH to have halted by
2015 and begun to reverse the incidence of malaria and other major diseases. CHWs collaborate with IHDPC8/Malaria Division, IHDPC/TB Division and other programs by moving curative and preventive care to the periphery, including key IMCI services through the work of CHWs.
EXPECTED OUTPUTS / OUTCOMES BASELINE 2011 TARGETS 2015 TARGETS 2018
% HIV prevalence among PW attending ANC
1.5 1 0.6
% HF with VCT and PMTCT services
94 96 96
% HF offering ART and HIV-HBV co-infection treatment
83 90 95
% Patients who need ART and receive it
90 94 96
Gains reducing HIV infection and AIDS
Rwanda has made extensive gains in the prevention of HIV using five integrated components: voluntary counseling and testing (VCT), PMTCT, male circumcision, BCC, and HIV treatment for scaling up prevention and treatment services at all levels. According to DHS 2010, approximately 79 percent of women and 74 percent of men have knowledge of HIV prevention.
As a result of the increasing capacity to provide VCT services, the number of clients tested for HIV/AIDS has grown steadily in the country. From 2003 to June 2011, a total of 7,306,000 tests were done for HIV in Rwanda. This number includes tests done in health facilities and mobile VCTs. The decentralization of PMTCT services has resulted in the extension of the coverage of PMTCT services. From July 2010 to June 2011, the number of pregnant women attending ANC was about 324,628. Almost all were counseled and tested for HIV and received their results, out of whom 6,594 (2.05%) tested HIV positive. The number of HFs providing post-exposure prophylaxis (PEP) services to its staff and to people accidentally exposed to blood is 336 / 481, which is 70 percent of all HF (hospitals + HCs).
Antiretroviral (ARV) treatment has also been decentralized in order to improve geographical accessibility and the continuity of care for people living with HIV/AIDS; from 4,200 patients in 2003, the number of patients under ARV treatment increased to 96,705 patients by June 2011 (based on CD4 count of 350), with a national coverage at 93 percent (based on UNAIDS EPi Spectrum model estimations).
Current HIV and AIDS challenges
However, the situation analysis and the Mid-term Review point out key challenges on what HSSP III needs to concentrate on to complete universal access for HIV prevention and treatment services. As clinical services are getting closer to universal coverage, it is becoming more challenging to reach the remaining potential beneficiaries, who are harder to reach. With the increase in number of people on antiretroviral therapy (ART), the workload and effort to ensure quality services is a growing challenge. Lab capacity is limited for treatment, monitoring, and HIV drug resistance surveillance as recommended by the HSSP II. Quality of treatment, management of treatment, failure and long-term co-infection management need improvement. Nonclinical prevention still has a lot of progress to make: innovative strategies require important changes in the working habits of health workers and other actors.
Program areas where targets are not fully met are youth prevention, most-at-risk population (MARPs) targeted interventions, male circumcision scale-up, female condom promotion, coverage of pediatric ART services, laboratory capacity decentralization and integration of HIV services at decentralized level. Quality of services can still be improved substantially. Maintaining sufficient and stable qualified staff at all health facilities represents the major constraint to expansion of activities with the required quality, partly due to high turnover of trained service providers. Rwanda needs to strengthen preventive measures in order to reach MARPs and to reduce significantly the prevalence, incidence, morbidity, and mortality resulting from HIV/AIDS and its burden on households, the health system, and the economy.
For HIV/AIDS, HSSP III will aim to: Reduce new HIV infections; Reduce morbidity and mortality;
Ensure equal opportunities for vulnerable groups and people living with HIV; Strengthen the quality management of HIV AIDS.
HIV and AIDS strategies and interventions
1. Reduce new HIV infections:
Sensitize the general population and key populations (sex workers, mobile populations, vulnerable children, and people with disabilities) on HIV prevention and ensure access to the minimum package of services;
Increase coverage of HIV counseling and testing services to the general population and integration of HIV testing with other routine services and screening programs (cancer, immunization, etc.);
Increase accessibility of male circumcision as an additional strategy for HIV prevention through advocacy and community mobilization;
Improve treatment monitoring and treatment as prevention, targeting key high-risk populations (sex workers, men having sex with men, sero-discordant couples); Improve condom accessibility and availability;
Capitalize and maintain PMTCT achievements toward EMTCT, work with HIV+ women to increase attendance to ANC and improve integration of PMTCT services within RH services. 2. Reduce morbidity and mortality:
Increase ARV accessibility and pediatric EID and ART coverage; Improve TB screening and treatment in HIV treatment settings;
Increase the skills and knowledge of providers in HIV management and comorbidities (STIs, HBV Infections, TB, and other opportunistic infections);
Improve the lab decentralization capacity for HIV, AIDS, STIs, and blood-borne infections; Remove socioeconomic barriers for HIV services and train health providers to provide
services in a non-stigmatizing and nondiscriminatory way.
3. Ensure equal opportunities for vulnerable groups and people living with HIV and AIDS (PLWHA): Strengthen social and economic protection and empowerment for PLWHA and orphans and
vulnerable children (OVC); Reduce stigma.
4. Strengthen the quality of management of HIV and AIDS:
Strengthen M&E systems for HIV at all levels; use data for decision-making; Emphasize pre-service training and align with the HRH strategic plan; Integrate HIV services within the CHW program;
Strengthen the multisectoral approach, especially mainstreaming gender in all HIV programs; Accelerate the integration of HIV care and treatment into the national health system and
improve and maintain quality of services.