Rwanda Study: Community-Based HIV Program Yields Excellent Outcomes

The study reviewed the records of over 1,000 patients and found that 92 percent of them were still taking their ART medications regularly, two years after they were enrolled in treatment at clinics supported by PIH’s Rwandan partner organization, Inshuti Mu Buzima (IMB). 

This retention rate far exceeds the average of 70 percent reported in a review of 39 published studies that looked at a combined 225,000 HIV patients across sub-Saharan Africa. And retention rates in North America were even lower, averaging just 55 percent, according to a review of 31 studies published in the Journal of the American Medical Association.

“This study reinforces published evidence demonstrating that HIV treatment outcomes in resource-limited setting can match or exceed those in wealthy countries,” write coauthors Michael Rich, MD, Ann Miller, PhD, and their colleagues from Partners In Health, Harvard Medical School, and the Rwanda Ministry of Health.

What makes IMB’s program different is the added support provided to patients. In addition to daily home visits from health workers, patients enrolled in the program received nutritional assistance for 10 months, a travel allowance for routine clinic visits, and comprehensive integrated medical care. They were also enrolled in support groups and HIV education programs.

“Excellent Clinical Outcomes and High Retention in Care Among Adults in a Community-Based HIV Treatment Program in Rural Rwanda” was published in the Journal of Acquired Immune Deficiency Syndromes in March 2012.

The costs and benefits of community health workers

Over the past decade, the number of people who receive antiretroviral therapy in low- and middle-income countries has increased from 200,000 to more than 6.5 million. However, one of the largest challenges facing patients who do have access to HIV/AIDS drugs – especially those living in extreme poverty – is their ability to take ART each day. Inconsistency can cause the virus to become resistant to medication, ultimately putting the patient’s life at risk.

Because HIV programs in poor countries are often based in health clinics, patients are forced to travel long distances for check-ups, blood tests, and medication refills. Patients who cannot afford to travel outside of their rural villages, to buy food, or to pay for out-of-pocket health care costs are less likely to take medications or make follow up visits to these difficult-to-reach clinics.

As part of its effort to break this cycle, the Government of Rwanda has been committed to universal free access to HIV care and has backed that commitment with increased investment in the health system since 2004.

The program has achieved impressive results. Nationally, Rwanda’s HIV program has a retention rate of 86 percent, with only 4.9 percent of patients being lost to follow-up care, according to a 2009 article in the Journal of Acquired Immune Deficiency Syndromes.

“While Rwanda has incredible retention rates, a difference of 5 percent in retention numbers still means that 5 more people of every 100 infected could still be receiving care,” continued Rich.

The daily visits from community health workers and other social supports provided in the IMB program cost an extra U.S. $630 per patient per year for the first year, and then U.S. $340 per year thereafter. Providing 10 months of nutritional support was the primary cost driver in the first year of treatment. The daily accompaniment component costs approximately U.S. $128 per patient per year.

“With PEPFAR [the U.S. President’s Emergency Plan For AIDS Relief] cutting back funding in Africa, we have to show the world that we need more investment in these programs,” concluded Rich. 

And with that increased investment, Rich believes, the international community can set and achieve a long-term retention goal of 90 percent for patients with HIV throughout sub-Saharan Africa. 

Read “Excellent Clinical Outcomes and High Retention in Care Among Adults in a Community-Based HIV Treatment Program in Rural Rwanda” in its entirety.
Learn more about PIH’s efforts to fight HIV.
Learn more about PIH’s program in Rwanda.