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.

Deteminants de l'utilisation des services de sante par les menages du district de Rubavu

L'utilisation des services de sante de base est l'un des facteurs clefs favorisant une meilleure sante des populations. Conceptuellement; si la qualite des services est l'une des explications du niveau d'utilisation; cette etude a essaye de montrer aussi l'importance d'un ensemble d'autres facteurs qui devraient etre pris en compte pour ameliorer la frequentation des services de sante. Les resultats de cette etude indiquent que pour le dernier episode de maladie; plus de 92 des malades ont recouru a differentes structures des soins modernes et 7;4 ont fait recours a la medecine traditionnelle. Pour la sante maternelle; l'utilisation des methodes contraceptives est de 29.5 et 73 d'accouchements ont ete assistes par un personnel qualifie. Parmi les 96 des femmes qui ont consulte les services de CPN pendant la grossesse; seulement 24 ont complete les quatre visites standards de CPN. Enfin; les resultats de cette etude montrent que l'utilisation des services de sante par les menages du District de Rubavu est fonction de differents facteurs lies tant a l'individu (age; sexe; niveau d'etudes du chef de menage.) qu'a l'environnement. Cette etude suggere enfin que des etudes approfondies d'envergure nationale soient envisagees pour s'enquerir de la situation; car tres peu d'etudes y relatives ont ete conduites