Esther Uwababyeyi’s journey with HIV began at a young age. “Since the age of three, I’ve been on HIV treatment,” she says. Born in 2002, Uwababyeyi was infected during her mother’s pregnancy, a time when access to HIV treatment for women living with HIV was just starting to improve. Now 22 years old and living in Rwanda’s Rwamagana district in the Eastern Province, she has benefitted greatly from the advancements in the country’s HIV treatment programme over the years.
In 2015, Rwanda updated its HIV treatment guidelines, aligning with World Health Organization (WHO) recommendation. With WHO support, the new guidelines advised that people living with HIV should begin antiretroviral treatment immediately after diagnosis, regardless of clinical symptoms or CD4 cell count. Despite this progress, people living with HIV still needed to visit the clinic monthly for monitoring, treatment refills and psychosocial support.
For Uwababyeyi, who was an adolescent at the time, visiting the clinic once a month was challenging. “During my high school years in boarding school, I faced stigma surrounding my HIV status. I was reluctant to disclose my status, fearing discrimination. To manage the monthly clinic visits, I had to come up with excuses for my absences each month,” she recalls.
In 2016, Rwanda adopted the WHO-recommended differentiated service delivery model, which simplifies and adapts HIV prevention, treatment and care services to better serve the individual needs of health clients and reduce the burden on the health system. This included multi-month dispensing of HIV treatment, allowing people to receive several months of medication at once.
People living with HIV who had been on treatment for at least 18 months and demonstrated good adherence and achieved successful viral suppression could refill their HIV treatment every three months. In 2020, this interval was extended to six months under the same conditions.
Dr Ribakare Muhayimpundu, the HIV/STIs/Tuberculosis/Hepatitis programme officer at WHO Rwanda highlights the significant benefits of the multi-month dispensing model for the HIV response. “It is one of the differentiated strategies that improved recipients’ adherence while alleviating the burden on the health care system from monthly visits,” she explains. WHO facilitated expert workshops to assess the feasibility of global guidelines within the country, helped define implementation needs, adapt tools and train health workers.
This innovation was transformative for Uwababyeyi. “In 2019, after successful suppression of my viral load and demonstrating adherence to treatment, I was enrolled in a three-month antiretroviral refill programme while still attending boarding school,” she recalls. “Throughout my final year of high school, my appointments were scheduled during end-of-term holidays, allowing me to complete my education without interruption.” Upon graduating in 2022, her adherence record led to an upgrade in her refill schedule to six months.
In 2027, the Ministry of Health, through the Rwanda Biomedical Centre (RBC), introduced a community-based peer education model alongside multi-month dispensing to maintain service quality. WHO worked with the country to design and adapt this model to the local context, develop criteria for peer educator selection, create a training manual and trained around 5,000 peer educators, working closely with networks of people living with HIV.
Havugimana Faustin, one of the trained peer educators from 2017, began HIV treatment in 2006, two years after his diagnosis. He was upgraded to three-month HIV treatment refills and elected as a peer educator. “I make monthly visits to check on people’s adherence and address any emerging issues, ensuring timely referral to healthcare facilities when necessary,” says Faustin. “I’m pleased to report that most of my peers exhibit good adherence and appreciate the benefits of the refill programme.”
These innovations, initiated nearly a decade ago, have significantly enhanced the quality of care within Rwanda’s health system and the quality of life of people living with HIV. They have also positioned Rwanda as a global leader in the HIV response. Rwanda is one of only five countries worldwide, along with Botswana, Eswatini, the United Republic of Tanzania and Zimbabwe, to have achieved the UNAIDS 95‒95‒95 treatment targets ahead of schedule. By 2025, these targets aim for 95% of people living with HIV to know their HIV status; 95% of people diagnosed with HIV to be on HIV treatment, and 95% of those on treatment to achieve viral suppression. Rwanda has surpassed these targets at 95%, 97.5% and 98% respectively.
“Multi-month drug dispensing has saved our patients time and money,” says Dr Simeon Tuyishime, the Director of HIV Care and Treatment at RBC. “Instead of monthly visits, many of our patients now visit health facilities every three to six months. This change saves them money on transportation and gives them more time to care for their families. This convenience has also enhanced treatment adherence and viral suppression.”
Distributed by APO Group on behalf of World Health Organization (WHO) – Rwanda.
