Is the Differentiated Service Delivery Model Suited to the Needs of People Living with HIV in Rwanda?

The primary goal of antiretroviral treatment is to improve the health of individuals with HIV, and a secondary goal is to prevent further transmission. In 2016, Rwanda adopted the World Health Organization's "treat-all" approach in combination with the differentiated service delivery (DSD) model. The model's goal was to shorten the time from HIV diagnosis to treatment initiation, regardless of the CD4 T-cell count. This study sought to identify perceptions, enablers, and challenges associated with DSD model adoption among PLHIV.This study included selected health centers in Kigali city, Rwanda, between August and September 2022. The patients included were those exposed to the new HIV care model (DSD) model and those exposed to the previous model who transitioned to the current model. Interviews and focus group discussions were also held to obtain views and opinions on the DSD model. The data were collected via questionnaires and audio-recorded focus group discussions and were subsequently analyzed.The study identified several themes, including participants' initial emotions about a new HIV diagnosis, disclosure, experiences with transitioning to the DSD model, the effect of peer education, and barriers to and facilitators of the DSD model. Participants appreciated reduced clinic visits under the DSD model but faced transition and peer educator mobility challenges.The DSD model reduces waiting times, educates patients, and aligns with national goals. Identified barriers call for training and improved peer educator retention. Recommendations include enhancing the DSD model and future research to evaluate its long-term impact and cost-effectiveness.

Perceptions and beliefs about cough and tuberculosis and implications for TB control in rural Rwanda.

SETTING: Two southern provinces of Rwanda, Butare and Gikongoro. OBJECTIVES: To identify beliefs and popular perceptions on cough and tuberculosis (TB) in rural Rwanda and determine how they shape health-seeking behaviour. METHODS: Eight focus group discussions, 21 key informant interviews and 12 illness narratives were conducted between May and June 2004. STUDY POPULATION: TB patients, community members, traditional healers and health workers. RESULTS: There is wide use of herbal treatment for chronic cough in Rwanda. Patients seek conventional care when alternative treatment options fail or when severe symptoms such as shortness of breath, bloody sputum and weight loss appear. There are several local illnesses associated with chronic cough, with different alternative treatments. TB symptoms are often mistaken for the acquired immune-deficiency syndrome (AIDS). Identified causes for cough-related illnesses can be classified as biomedical (germs, internal body dysfunction and worms), environmental (seasonal changes and dust), cultural (inheritance), socio-economic (hard work, malnutrition and tobacco), and supernatural (witchcraft). Three health-seeking end points emerge for chronic cough: home care, health facility and the traditional healer. Healers in some areas, however, believe TB due to witchcraft can only be treated traditionally. CONCLUSION: This study unveils beliefs and treatment options for chronic cough in Rwanda, with important implications for TB control that should be addressed.

One-stop TB-HIV services evaluation in Rwanda: comparison of the 2001-2005 and 2006-2010 cohorts.

BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection remains high in Rwanda. Since one-stop TB-HIV services were implemented to manage TB-HIV co-infection, their functioning and impact on TB treatment outcomes have not been assessed. OBJECTIVE: To evaluate one-stop TB-HIV services in Rwanda by comparing the TB treatment outcomes before and after their implementation in Kicukiro and Rulindo districts. METHODS: This descriptive retrospective study used a quantitative questionnaire to determine the functioning of Rwanda's one-stop TB-HIV services. In-depth interviews and focus group discussions with health care providers, heads of facilities and co-infected patients were held to seek their opinion about the functioning of the services. RESULTS: The one-stop TB-HIV services at all 12 health facilities visited were functioning according to the approved criteria. However, TB treatment outcomes after the intervention were not statistically different from those before the intervention. Qualitative data showed a positive impact on the quality of service, particularly a reduction in waiting times and appointments that were better respected as a result of the efficient functioning of the services. CONCLUSION: One-stop TB-HIV services have improved the quality of service in Kicukiro and Rulindo districts. However, the services need to be strengthened programmatically to improve TB treatment outcomes.

Contexte : Une co-infection par la tuberculose (TB) et le virus de l'immunodéficience humaine (VIH) reste fréquente au Rwanda. Depuis que des services TB-VIH à guichet unique ont été mis en œuvre afin de prendre en charge cette co-infection TB-VIH, leur fonctionnement et leur impact sur les résultats du traitement de la TB n'ont pas été évalués.Objectif : Evaluer les services TB-VIH à guichet unique du Rwanda, en comparant les résultats du traitement de la TB avant et après leur mise en œuvre, dans les districts de Kicukiro et Rulindo.Méthodes : Un étude descriptive rétrospective et un questionnaire quantitatif ont permis de connaître le fonctionnement du service TB-VIH à guichet unique ; des entretiens approfondis et des discussions en groupes focaux avec les prestataires de soins, les directeurs des structures et les patients co-infectés ont permis de connaître leur opinion à propos du fonctionnement.Résultats : Après la mise en œuvre des services TB-VIH à guichet unique, les 12 structures de santé visitées fonctionnaient selon les critères établis. Cependant, les résultats du traitement de la TB n'ont pas été significativement différents avant et après l'intervention. Les données qualitatives ont mis en évidence un effet positif de l'intervention sur la qualité de service, notamment sur la réduction du temps d'attente, et sur un meilleur respect des rendez-vous en réponse au bon fonctionnement du service.Conclusion : Les services TB-VIH à guichet unique ont amélioré la qualité des services dans les districts de Kicukiro et Rulindo. Cependant, le service doit être renforcé en termes de programme afin d'améliorer les résultats du traitement de la TB.

Marco de referencia: La frecuencia de coinfección por el bacilo de la tuberculosis (TB) y el virus de la inmunodeficiencia humana (VIH) sigue siendo alta en Rwanda. Desde que se introdujeron los servicios de 'ventanilla única' de atención de la TB y la infección por el VIH con el fin de atender a los pacientes aquejados de coinfección no se ha llevado a cabo una evaluación de su funcionamiento ni de su impacto sobre los desenlaces terapéuticos de la TB.Objetivo: Evaluar los servicios de ventanilla única de atención de la TB y la infección por el VIH en Rwanda, mediante la comparación de los desenlaces del tratamiento antituberculoso antes y después de la introducción de los servicios en los distritos de Kicukiro y Rulindo.Métodos: Fue este un estudio descriptivo retrospectivo, en el cual se administró un cuestionario cuantitativo con el fin de conocer el funcionamiento de los servicios de ventanilla única; se practicaron entrevistas exhaustivas y debates en grupos de opinión dirigidos a los profesionales de salud, los gestores de establecimientos y los pacientes aquejados de coinfección con el objeto de conocer sus opiniones sobre el funcionamiento de los servicios.Resultados: Después de la introducción de los servicios de ventanilla única de atención de la TB y la infección por el VIH, los 12 establecimientos visitados funcionaban de conformidad con los criterios fijados. Sin embargo, los desenlaces del tratamiento antituberculoso después de haber iniciado la intervención no fueron estadísticamente mejores que los resultados anteriores a la misma. Los datos cualitativos pusieron en evidencia un efecto positivo de la intervención sobre la calidad del servicio, sobre todo con respecto al tiempo de espera y al cumplimiento de las citas, como resultado del buen funcionamiento del servicio.Conclusión: El sistema de ventanilla única de atención de la TB y la infección por el VIH ha mejorado la calidad de los servicios prestados en los distritos de Kicukiro y Rulindo. Sin embargo, se precisa un refuerzo programático encaminado a mejorar los desenlaces del tratamiento antituberculoso.