Integrating tuberculosis and HIV care in rural Rwanda.

SETTING: Rwanda has generalised human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics. The Rwandan Ministry of Health approved a policy on TB-HIV collaborative activities in 2005. The present study is a report on the results of the integrated TB and HIV activities at a rural health care site between July 2005 and June 2006. METHODS: Activities included provider-initiated HIV testing and counselling (PITC) of TB patients and the implementation of a standardised TB screening questionnaire for in-patients on medical wards and HIV-infected out-patients. RESULTS: Of a total 259 TB patients registered, 87% with unknown HIV status or who were HIV-negative accepted PITC. Overall, 48% (125/259) of TB patients were HIV-infected. The proportion of TB patients ever tested for HIV increased from 82% (138/169) in 2004-2005 to 93% (240/259) in 2005-2006 (P < 0.001). Of the 770 in-patients screened for TB, 162 (21%) tested positive, of whom 53 (33%) were diagnosed with TB; 39 (76%) of these were HIV co-infected. Three hundred out-patients with HIV were screened for TB; 80 (27%) tested positive, of whom 11 (14%) were diagnosed with TB. DISCUSSION: Activities integrating TB and HIV were feasible in a rural health care setting. PITC was successful in TB patients and unrecognised TB was common, particularly among HIV-infected in-patients.

Prevalence and risk factors for trachoma in Rwanda.

OBJECTIVE: Trachoma is the oldest blinding ocular infection that has well known predisposing risk factors for its transmission. The prevalence of trachoma in Rwanda has been unknown as no trachoma population-based survey had ever been undertaken. The aim of this study was to determine the prevalence of Trachoma and assess associated risk factors for its transmission. METHODS: A population-based cross-sectional study of children aged 1 to 9 years and adult women aged 15 and above. Study setting was Gatsibo (Eastern Province) and Nyaruguru (Southern Province) Districts, Rwanda. Clusters were selected through probability proportion-to-size sampling and eligible persons were sampled using a systematic random sampling method. Data were collected using three generic survey questionnaires (village, household and individual level) as recommended by the World Health Organization (WHO). RESULTS: 3451 children and 1,841 adult women underwent ocular examination for trachoma assessment. The prevalence of trachomatous inflammation-follicular (TF) among children was 1.32% [95% CI, 0.77-1.86] in Gatsibo and 0.73% 195% CI, 0.33-1.13] in Nyaruguru Districts, respectively; with both districts having a prevalence below the WHO/International Trachoma Initiative (ITI) cut-off point of 10% for trachoma to be taken as disease of public health importance. There was no case of blinding trachomatous trichiasis and corneal opacity in both districts. Risk factors present for trachoma transmission were minimal. CONCLUSION: Trachoma is not a disease of public health importance in Gatsibo and Nyaruguru Districts in Rwanda