Rwanda is one of the countries that have made significant achievements in managing HIV/AIDS, having reached the 95-95-95 target set by the Joint United Nations Programme on HIV/AIDS (UNAIDS).
The 95-95-95 target aims at diagnosing 95 per cent of all HIV-positive individuals, providing antiretroviral therapy (ART) for 95 per cent of those diagnosed, and achieving viral suppression for 95 per cent of those treated by 2030.
After attaining the milestone, Rwandan medics now face the question of how to reach the minority who, for some reason, don't know that they are HIV positive and thus are not on medication.
There are an estimated 5,400 new cases of HIV annually among adults in Rwanda, according to the Rwanda Population-Based HIV Impact Assessment (RPHIA), a national household-based survey that was conducted between October 2018 and March 2019.
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The National HIV programme recognises that there are gaps hindering a sustained epidemic response, and key of these, are people who don't know their status and thus are not taking medication.
"The entire cascade of the HIV continuum of care starts with knowing your HIV status, which refers to the proportion of people who have tested positive and linked to the care and treatment," reads part of the programme.
It is estimated that the country has more than 230,000 people living with HIV, but out of these, around 10,000 are not taking medication despite the fact that it is provided free of charge. This is five per cent of the total infected people.
UNAIDS Rwanda country director, Hind Hassan Abdelgalil, told The New Times that Rwanda's achievements in testing and treating people are quite commendable, but noted that the next step of reaching out to the five per cent who are not yet on treatment will require great work.
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"There's only five per cent left as a gap right now. This is usually the most difficult because it's the last mile of the programme. Rwanda may have to rework, rethink, reimagine the programme at this stage to see how they can focus, be precise, more efficient, use less resources," she said.
Currently, something is being done in regards to such. Since 2018, the National HIV programme started an active case-finding strategy that aims to detect undiagnosed HIV cases from the index (already known positive) followed at health facilities.
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The strategy uses different techniques to reach the elicited contact of the index, who is invited and tested at a health facility to ensure adequate linkage to care and treatment if tested positive, or HIV prevention methods if tested negative. This remains the golden approach to identifying the small proportion of cases still undiagnosed.
Furthermore, there are various testing strategies that the national programme is using to reach hard-to-reach groups, including using peer support and distributing HIV self-testing kits to individuals who are reluctant to get tested at health facilities. The kits are also available at private pharmacies.
Muhammed Semakula, the Head of the Department of Planning, Monitoring and Evaluation, and Health Financing at the Ministry of Health, said the country is implementing a test-and-treat approach so that when someone is identified as HIV-positive, they immediately start treatment.
"If someone is being treated and is suppressing the virus, the possibility of transmitting the disease is very minimised," he noted.
