HIV-positive Rwandans in discordant relationships will start taking antiretroviral treatment (ART) as soon as they test positive as part of a plan to boost national HIV prevention and treatment efforts.
"There is evidence that antiretroviral treatment, once started early for eligible HIV-positive patients, alleviates their suffering and reduces the devastating impact of the pandemic," Anita Asiimwe, head of the Institute of HIV/AIDS Disease Prevention and Control, told IRIN/PlusNews. "Antiretroviral therapy has the potential both to reduce mortality and morbidity rates among HIV-infected people, and to improve their quality of life."
In May 2011, a landmark study - HPTN 052 - showed major reductions in HIV transmission among discordant couples due to early treatment. The authors of the nine-country study concluded that earlier initiation of HIV treatment led to a 96 percent reduction in HIV transmission to the uninfected partner.
According to the government, an estimated 7.1 percent of cohabiting couples seeking voluntary counselling and testing services in the capital, Kigali, are HIV discordant. Infections within stable relationships have been identified as one of the main sources of new cases in Rwanda.
Rwanda has a successful ART programme; Asiimwe said the country had achieved 93 percent coverage of people needing treatment under UN World Health Organization (WHO) guidelines, which recommend initiation of treatment at a CD4 count - a measure of immune strength - of 350 and below.
"HIV-positive people in discordant relationships will start ART regardless of their CD4 count," said Sabin Nsanzimana, coordinator of the HIV and Sexually Transmitted Infections (STI) Care and Treatment Department at the Ministry of Health's Centre for Treatment and Research on AIDS, Malaria, Tuberculosis and other Epidemics, TRAC Plus. "We hope to start as soon as the guidelines are approved at the senior management meeting and [endorsed by] the Ministry of Health."
Rwanda is going ahead despite the fact that WHO has not yet released prevention guidelines for discordant couples. At an International AIDS Society conference in Rome in July, the head of WHO's HIV/AIDS department, Gottfried Hirnschall, said the organization had delayed the release of guidelines following the HPTN 052 results.
Nsanzimana said the added cost of putting thousands more people on treatment would be compensated for by the reduction in new HIV infections and treatment down the line.
"This strategy will help us make gains on those who will be prevented from infection since these won't have to be treated or even followed up with much money," he said.
|When my wife was pregnant, she took the mandatory HIV test at the health centre and it was positive. Now why should I go for testing... If she has it [HIV], I definitely have it too|
The Rwandan government will have to intensify awareness-raising campaigns: HIV testing remains low, especially among couples.
"When my wife was pregnant, she took the mandatory HIV test at the health centre and it was positive. Now why should I go for testing to make a mockery of myself?" said Gregory Ruseesa, a taxi tout in suburb of Nyabugogo in the capital, Kigali. "If she has it [HIV], I definitely have it too."
The head of HIV and STI care and treatment at the Rwanda Biomedical Centre, Muhayimpundu Ribakare, said: "Here in Rwanda it's just very few couples that go for HIV voluntary counselling and testing services; of course this means they are not aware of their HIV status - if they are positive they end up infecting their partners.”
According to Nsanzimana, the government will also need to intensify its efforts to improve ART adherence to ensure patients do not develop resistance.
"A patient on ART who doesn't follow prescription and, say, skips a dose, is likely to get the drug-resistant HIV," he said. "Once this happens, the resistant HIV requires another type of medication which is expensive."