How PEPFAR has enhanced Rwanda’s response to HIV/AIDS with US$1.6 billion investment

By Théophile Niyitegeka
On 8 January 2022 at 09:00

In 2003, the then US President George W. Bush launched the US President’s Emergency Plan for AIDS Relief (PEPFAR). One year later, the program was extended to Rwanda to enhance the country’s response to HIV/AIDS which has yielded big over the years.

The program’s interventions draw emphasis on mass tests and helping HIV positive patients to prevent further transmission of new infections among others.

Speaking to IGIHE, the coordinator of PEPFAR in Rwanda, Alexandra Hoagland has reflected on the program’s achievements and commended Rwanda’s efforts to implement policies aimed at fighting against HIV/AIDS.

“More recently, PEPFAR has been investing in a lot of systems in Rwanda, specifically in all countries of intervention. When I say systems, I mean data collection systems, laboratory systems and how we purchase drugs that are used to treat HIV/AIDS,” she said.

“There has been a lot of successes but I will just highlight a couple. First, HIV positive patients were helped to access medication. For many people who were diagnosed in the 1999 and 2000, it was a stressful time because they didn’t know how they were going to survive. People were getting sick quickly but with the introduction, patients got relief. When they take medication as prescribed, they live long and lead healthy life,” added Hoagland.

She explained that PEPFAR has supported that through the clinical services provision and other interventions including the prevention of mother to child transmission for HIV positive pregnant mothers.

Considering Rwanda’s remarkable progress towards HIV/AIDS response, Hoagland expressed optimism that with proper diagnosis and treatment, the risk of transmission can be minimized.

“Now, Rwanda has a huge success story. 98.4% of HIV positive pregnant mothers do not pass on HIV to their children. It is a tremendous success which other countries should learn from,” added Hoagland.

Before 2016, a patient tested positive for HIV had to wait for some time to start receiving treatment but the situation has changed as patients start receiving medication soon after testing positive to strengthen his/her body’s immunity.

Hoagland who has been working in the health sector for the past 12 years has told IGIHE that men circumcision was among other programs that helped Rwanda to fight against HIV/AIDS.

Health experts show that circumcising men reduces HIV transmission by 60%.

Figures from PEPFAR Rwanda indicate that a total of 1,227,295 men had undergone voluntary circumcision in Rwanda by September 2021.

“It is a great investment because it is a one-time procedure that gives lifetime protection. Circumcision does not mean you can go freely but one sure thing is that it offers certain level of protection,” Hoagland observed.

The coordinator of PEPFAR in Rwanda, Alexandra Hoagland.

Rwanda’s promising efforts

As of today, Rwanda registers 220,000 HIV positive patients equivalent to 3% of the population while the African continent has about 23.8 million.

Overall, the research carried out by Rwanda Biomedical Center (RBC) in November 2020 indicated that new HIV positive cases reduced by half between 2015 and 2019 while transmission of the virus from mother to child was cut to less than 2 percent in the past four years.

The research also highlighted that 5400 people catch HIV every year in Rwanda where the majority are from urban areas.

Through PEPFAR; a total of 125,789 HIV/AIDS patients receive antiretroviral therapy while 246,716 HIV/AIDS orphans and underprivileged children also receive different kinds of support.

PEPFAR helps them through provision of screening for sexually transmitted infections and training helping to reach other segments of the population in need of support.

Hoagland has also attributed Rwanda’s success to collaboration with different institutions.

“What is interesting to see in Rwanda, is that the Ministry of Health makes decisions that are in the best interests of the people of Rwanda,” she said.

Rwanda has ambitious targets to achieve zero new HIV infections by 2030.

The milestone will complement the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal to achieve universal access to HIV treatment by 2020.

The goal (90-90-90) read that 90% of all people living with HIV would know their HIV status, 90% of all people diagnosed with HIV infection would receive sustained antiretroviral therapy while 90% of all people receiving antiretroviral therapy would have had the viral suppression by 2020.

“Rwanda has achieved the target. We are now working towards 95-95-95 goal. To achieve an AIDS free generation, we have to work in parallel working with people who don’t know their HIV status ensuring that they are tested and those who tested positive to receive treatment,” Hoagland said.

In Rwanda, at least 98% of the population was tested for HIV. PEPFAR continues to work with relevant institutions to test groups of people vulnerable to new infections including sex workers to be tested.

“I am confident that Rwanda will be one of the first countries to achieve these targets. The country has been expending much effort to achieve envisaged goals and ensure citizens receive needed services,” Hoagland underscored.

Dr. Nkengasong’s anticipated contribution

In September 2021, the United States President Joe Biden made official his intent to nominate Dr. John Nkengasong as the head of PEPFAR.

His nomination is good news for Rwanda and African continent in the fight against HIV/AIDS.

Hailing from Cameroun, Dr John Nkengasong currently serves as the first Director of the Africa Centres for Disease Control and Prevention (Africa CDC). He is a leading virologist with nearly 30 years of work experience in public health.

Prior to his appointment with Africa CDC, he was the Deputy Principal Director (acting) of the Centre for Global Health at the United States Centres for Disease Control and Prevention, and Associate Director of Laboratory Science and Chief of the International Laboratory Branch at the Division of Global HIV/AIDS and TB.

Hoagland said that Dr. Nkengasong has a lot to offer along the journey to combat HIV.

“We look forward to working with him as someone coming with a very interesting background. He worked in different African countries and now as the head of CDC that he has great experience. Besides, being from Cameroun helps giving him some context. As PEPFAR Rwanda, we are excited to work with him and see how he wants to put the program forward,” she noted.

Figures released by WHO in November 2021 show that HIV continues to be a major global public health issue, having claimed 36.3 million lives so far.

There is no cure for HIV infection. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.

PEPFAR is regarded as one of the most effective and efficient U.S. foreign assistance programs. By focusing its efforts on where the AIDS epidemic is the largest and the need is the highest, PEPFAR hastens progress towards ending the epidemic, and reduces the future costs required to sustain the HIV/AIDS response.

Through PEPFAR, the U.S. government has invested nearly $100 billion in the global HIV/AIDS response, the largest commitment by any nation to address a single disease in history, saving 21 million lives, preventing millions of HIV infections, and accelerating progress toward controlling the global HIV/AIDS epidemic in more than 50 countries.

Rwanda has been commended for efforts to implement policies aimed at cutting new HIV infections to zero by 2030.